Anaemic Patient Disease Questions and Physical Exam Findings Nausea Vomit Dizziness Fatigue Abdominal pain: Gnawing or burning Epigastric Change in appetite. Indigestion Reflux Bloating Gastrointestinal reflux Peptic ulcer Bloating and abdominal fullness Alcohol history Smoking history Past infection history, GIT history, haematological history Medications: NSAIDs Social history: Diet -> high fruit intake, vegetables, fibre and vitamin A -> protective against peptic ulcer. Psychological factors: anxiety, stress and PTSD. Differentiating between gastric and duodenal ulcer: Gastric -> pain increases shortly after eating. Peptic -> pain relieved with food and pain increases 2 – 5 hours after eating. Nocturnal pain -> more common in peptic ulcer. Vomiting of blood Perforated peptic Abdominal distension ulcer Altered bowel habits Fever Fatigue Night sweats Weight changes Appetite changes Altered bowel habits. Signs of gastric outlet obstruction: Dysphagia Abdominal pain Early satiety (appetite changes) Nausea and Vomiting Hematemesis Stomach cancer Melena Swallowing difficulties Smoking history Past medical history: malignancy and infections Physical exam findings: Palpable mass in the epigastric tumor. Signs of malignant disease: Left supraclavicular adenopathy -> Virchow node. Hepatomegaly Ascites Palpable umbilical node -> sister Mary Joseph Node Palpable mass on digital rectal examination -> Blumer shelf Ovarian mass -> krykenbeg tumor Fever Nausea Fatigue Vomit Weight loss Appetite change Gastritis Dyspepsia Early satiety Altered bowel habits. Medications: Prescription Non-prescription Social history Pain on swallowing Difficulty swallowing Unintentional weight loss Signs of anaemia Signs of advanced disease: Progressive structural dysphagia Retrosternal structural dysphagia -> from solids to liquids. Cervical adenopathy. Oesophageal cancer Hoarseness and/or persistent cough Horner syndrome -> miosis, partial ptosis and facial anhidrosis Signs of upper GI bleed: Hematemesis Melena Family history Diet Alcohol Past medical history: malignancy, infectious, GIT disease Vomit Dizziness Hematochezia Bleeding oesophageal varices Melena Hematemesis Abdominal distension Alcohol history Nausea Vomit Hematemesis Mallory Weiss Tear Painful swallowing Swallowing difficulties Epigastric or back pain. Social history: diet and alcohol Testes and procedures: endoscope band ligation, endoscope ultrasound and endoscopy. Family history Bleeding disorders Past medical history: malignancy disorders Haematological disease history Fever Fatigue Dizziness Abdominal pain Appetite change Abdominal distension Unintentional weight loss Altered bowel habits. Family history Social history: diet, alcohol etc. Testes and procedures: Cancer screening Most recent cancer screening. Colorectal Cancer Colonoscopy FOBT Past medical history Malignancy GIT disease Right sided colon carcinoma: (38% of all carcinomas) Occult bleeding or melena. Manifests as iron deficiency anaemia -> due to chronic bleeding. Diarrhea Left sided colon carcinoma: (28% of all carcinomas) Changes in bowel habits -> change in size, consistency and frequency -> more common in left sided carcinomas as the faeces are more liquid in the proximal colon and left colon carcinomas tent to obstruct the lumen more than the right-sided carcinomas due to lumen size. Blood-streaked stools Colicky pain