Constipation Questions to ask for a patient with constipation. Character Qualitative – severity: Ability to flatulate Affecting daily life Asking generally Time course Change over time. Duration Frequency of episodes Onset Pervious episodes Relieving factors: Ask generally. Ask about laxatives. Aggravating factors Ask generally about aggravating factors. Medications Context at onset Diet Associated features Fever Shock Nausea Vomit Weight loss Night sweats Abdominal pian Appetite changes Balance difficulty Abdominal distension Altered bowel habits. Altered mental status. Difficulty swallowing Medications Prescription Non-prescription Supplements Past medical history Ask generally. Ask about GIT. Past surgical history Family history Social history Diet Alcohol Smoking Recreational drugs Occupational history Disease Questions and Physical Examination Findings Abdominal pain: Colicky Constant Progressively worse Fever Nausea Vomit Late onset Initially bilious Progresses to faecal vomiting in the presence of faeces in the vomit. Weight loss Large bowel obstruction Night sweats Abdominal distention Altered bowel habits. Constipation -> early onset -> especially in distal LBL. Past medial history Past surgical history Examination findings: Signs of dehydration -> hypotension and dry mucus membranes. Diffuse abdominal tenderness. Tympanic percussion -> due to gaseous distension of the bowel. Increased high-pitched bowel sounds (early) and absence of any bowel sounds (late). Collapsed empty rectum on DRE in complete bowel obstruction. Low grade fever Sigmoid colon most affected -> left quadrant pain Possibly a tender, palpable mass (peri colonic inflammation) Diverticulitis Change in bowel habits -> constipation in 50% of cases and diarrhea in 25-35% of cases. Increase in urinary urgency and frequency in 50% of cases and sterile pyuria (irritation of the bladder is cause by the proximity to an inflamed sigmoid colon). Acute abdomen -> indicates possible perforation and peritonitis. Rarely hematochezia. Nausea Vomit Abdominal pain Ileus Abdominal distension Altered bowel habits. Past surgical history. Nausea Vomit Abdominal pain Inguinal hernia Social history: Smoking Past surgical history Small bowel obstruction Abdominal pain Frequency Intensity Localisation generally widely varies from a patient to another. Typically related to defecation. Abdominal distension Altered bowel habits: Ask generally. Diarrhoea Constipation Mucus in stools. Faecal urgency Painful defecation Other GIT symptoms: Irritable bowel syndrome Nausea Reflux Early satiety Passing of mucus Abdominal bloating. Extraintestinal symptoms: Generalised somatic symptoms -> pain or fatigue as in fibromyalgia. Disturbed sexual function. Increased urinary frequency and urgency. Dysmenorrhea Physical examination: Normal Past medical history: GIT disease history Mental health history