How to take a detailed history of gastrointestinal symptoms

In this video, we'll take a look at the main abdominal complaints that patients typically present and figure out which area of the GI tract is likely to be responsible.

Olutayo A. Sogunro, DO, FACS, FACOS
Olutayo A. Sogunro, DO, FACS, FACOS
26th Nov 2020 • 3m read
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When your patient presents with specific gastrointestinal symptoms, do you know how to trace these symptoms back to the anatomical region that may be causing them? In this video, we'll take a look at the main abdominal complaints that patients typically present and figure out which area of the GI tract is likely to be responsible.

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Video transcript

In this lesson, I will discuss some common gastrointestinal symptoms a patient may present with when their chief complaint is abdominal pain. This list is not comprehensive, but it includes common ones that will help you focus in on specific history questions. Just a quick reminder about our old cards acronym, used for asking the history of present illness.

It is used during the subjective portion of the exam. I will be using S to mean symptoms, to describe the associated symptoms. The gastrointestinal system, also known as the digestive system, or alimentary canal, is an origin system that is responsible for the transportation, digestion and absorption of food and nutrients.

It contains hollow viscous organs, including the mouth, esophagus, stomach, small intestine, large intestine, and solid organs, including the liver, gallbladder, and pancreas. I have found it useful to identify the cause of abdominal symptoms by remembering the anatomical origin of the intestines. The GI tract is divided into three broad anatomical regions, that are formed during embryonic development.

The floor gut, mid gut, and the hind gut. The floor gut spans from the mouth to the second portion of the duodenum, part of the small intestine. The mid gut spans from the distal aspect of the second portion of the duodenum, to the proximal two thirds of the transverse colon. The hind gut spans from the distal one third of the transverse colon to the proximal two thirds of the anus.

Symptoms that may be considered for gut symptoms include vomiting, reflux associated with heartburn, dysphasia, difficulty in swallowing, hematemesis, which is the vomiting of blood, usually from a source of the upper GI tract. It's important to note that this is not to be confused with haemoptysis, which is the coughing up of blood associated with the source in the respiratory tract early satiety is where you feel full quickly, even after only a small amount of food, belching and singultus, also known as hiccuping.

It is a sound made by rapid closure of the glottis, due to a reflex spasm of the diaphragm, often a symptom of indigestion. Symptoms that may be considered mid gut symptoms include anorexia, loss of appetite, or flatulence. Symptoms that may be considered hind gut symptoms include diarrhea, constipation, commonly defined as fewer than three bowel movements per week.

Obstipation, the inability to pass stool or gas. Melena, the passage of dark tarry stools, commonly come from an upper GI source, but it is important to mention here that it can be due to GI bleeding anywhere in the GI tract. The passage of bright red blood per rectum or hematoquezia is similar to melena in that it can come from anywhere in the GI tract, often a lower source.

As a note, the most common cause of a lower GI bleed is from an upper GI source. The other common gastrointestinal symptoms that don't easily fall into a category are fever, malaise, a lack of well being, an overall feeling of discomfort, nausea, weight loss, or gain that is often not intentional. Icterus or jaundice, which is yellowing of the skin or sclera, this is referred to as scleral icterus.

Edema and bloating may also be associated with pain. It is also extremely helpful to ask about associated symptoms, and when they occur. Do they occur before, after, or during the pain? There are several other symptoms the patient may complain of when they experience abdominal pain. Oftentimes, these can coexist with the chief complaint of abdominal pain. These other symptoms can be within the neurological and gynecological systems. These will not be extensively covered in this lesson.