Medical History Taking in Gastroenterology & Hepatology

1. Medical History TakinginGastroenterology & Hepatology Mohssen Nassiri Toosi, MD

2. Medical History Taking in GI & Liver Disease • What is the purpose of medical history taking? • Patient introduction • Patient main problem understanding • Patient problem solving approach • Patient medical differential diagnosis • Patient problem treatment • Patient satisfaction

3. Medical History Taking in GI & Liver Disease • Types of medical history taking • Emergent situations • Cover patient life first • Out-patient situation • Cover brief, focused, and problem-oriented history • In-Patient situation • Cover comprehensive history

4. Medical History Taking in GI & Liver Disease • Types of medical history taking • Emergent situations • Know emergent situations • Think about emergent situation • Understand emergent situation on a patient • Do emergent actions to cover life • Take emergently-needed history • Resuscitate emergent condition • Take complete comprehensive history

5. Medical History Taking in GI & Liver Disease • Types of medical history taking • What are Emergent situations • Life-threatening situations • Airways problems • Severe dysphagia and breathing problem due to Food impaction • Breathing problems • Severe chest pain and dyspnea due to Diaphragmatic hernia • Abdominal pain, hypotension and dyspnea due to hydatid cyst rupture anaphylaxis • Circulation problems • GI bleeding and severe blood loss (massive) • Abdominal pain and shock

6. Medical History Taking in GI & Liver Disease • Emergent medical history taking • Secure airway, breathing, and circulation • Control vital signs • Open veins for IV access • Take blood sample for examination • Take history to assess severity (Assessment) • Start Resucitation and emergent treatments • Start problem-base history taking

7. Medical History Taking in GI & Liver Disease • Emergent medical history taking in GI bleeding • Assessment • BP, orthostatic change, PR, skin and mocosa, Urine output • CBC, PLT, BUN, Creatinie, PT (INR), ABO blood group • Resucitation • IV fluid, Oxygen, Appropriate blood product • Start problem-base history taking • PUD, Retching, Drug (ASA) intake, Malignancy,Liver diasease, surgery, ….

8. Medical History Taking in GI & Liver Disease • Types of medical history taking • Out-patient situation • Cover briefly focused, problem-oriented history • There is no emergent situation. • Patient is in a stable condition. • This is the first visite. • You know the patient from before. • You have less time for each patient.

9. Medical History Taking in GI & Liver Disease • Parts of a medical history • Identifications (patient ID) • Chife complaint • Present illness • Past medical history • Review of system • Physical examination • Problem list • Differential diagnosis

10. Medical History Taking in GI & Liver Disease • Parts of a medical history • Identifications (patient ID) • name • age • gender • birth place • ethinicity • occupation • education level • marrigae status • family size • Religious • …….

11. Medical History Taking in GI & Liver Disease • Parts of a medical history • Identifications (patient ID) • What is its purpose? • Patient introduction • better Patient-problem solving approach • better Patient-problem treatment

12. Medical History Taking in GI & Liver Disease • Parts of a medical history • Identifications (patient ID) • Chife complaint (CC)

13. Medical History Taking in GI & Liver Disease • Parts of a medical history • Identifications (patient ID) • Chife complaint (CC) • What is CC? • The main cause of referring patient to doctor • Usually single ( but sometimes more than one ) • By patient,s words ( but be sure it is reliable )

14. Medical History Taking in GI & Liver Disease • Parts of a medical history • Identifications (patient ID) • Chife complaint (CC) • What is CC? • The main cause of referring patient to doctor and the most important complaint for patient • Patient usually has many complaints • Sometimes it is more than one • The main request of patient is important • Sometimes it is not a physical complaint

15. Medical History Taking in GI & Liver Disease • Parts of a medical history • Identifications (patient ID) • Chife complaint (CC) • What is CC? • The main cause of referring patient to doctor • Usually single • To be main and major not accessory ones • Sometimes it is multiple • Make a syndrome from multiple CCs

16. Medical History Taking in GI & Liver Disease • Parts of a medical history • Chife complaint (CC) • Make a syndrome from multiple CCs • Jaundice • Fever • Chills • Abdominal pain • Abdominal pain • Jaundice • melena • Sever abdominal pain • Interactible vometing

17. Medical History Taking in GI & Liver Disease • Parts of a medical history • Identifications (patient ID) • Chife complaint (CC) • What is CC? • The main cause of referring patient to doctor • Usually single • By patient,s words • Not by physician interpretation but by physician guidence • Patient,s words must be reliable and correct • It need mutual conversation and dialoge

18. Medical History Taking in GI & Liver Disease

19. Medical History Taking in GI & Liver Disease • Parts of a medical history • Identifications (patient ID) • Chife complaint • Present illness • What is present illness? • It is to understand better CC. • It consists of all medical history related to CC. • It could include all PMH, DHx, and Lab tests, except physical examination. • It must clear and describe all medcial aspects of CC. • It is main part of medical history. • It must lead to differential diagnosis.

20. Medical History Taking in GI & Liver Disease • Parts of a medical history • Identifications (patient ID) • Chife complaint • Present illness • Levels of present illness • Level 1 • Level 2 • Level 3

21. Medical History Taking in GI & Liver Disease • Parts of a medical history • Present illness • Levels of present illness • Level 1 • Patient talk and doctor listen • Let patient feels free • Guide patient to talk about CC • It is like a story of CC from patient side • Do not take many time and do not need special knowledge

22. Medical History Taking in GI & Liver Disease • Parts of a medical history • Present illness • Levels of present illness • Level 2 • Doctor make fixed question and patient make answer • Base on a prototype questions to describe CC • Can change in different CC • Location, radiation, timing, aggrevating factors, relieving factors, relations, associations, changing through time • Try to describe CC completely • Need medical knowledge • Prepare for starting differential diagnosis

23. Medical History Taking in GI & Liver Disease • Parts of a medical history • Present illness • Levels of present illness • Level 3 • Doctor make oriented question and patient make answer • Base on speculated differential diagnosis (D.Dx) • Need generation of differential diagnosis • Need knowledge and study on each D.Dx • Need generation of DD-oriented questions • D.Dx are completed in progress

24. Medical History Taking in GI & Liver Disease • Parts of a medical history • Identifications (patient ID) • Chife complaint • Present illness • Past medical history • Review of system • Physical examination • Problem list • Differential diagnosis D.Dx D.Dx D.Dx

25. Medical History Taking in GI & Liver Disease • Levels of a present illness Complete D.Dx Level 3 Completing present illness D.Dx oriented questions Starting D.Dx Level 2 Medical description of CC Fixed questions about CC Better understanding CC Level 1 Patient story about CC Patient talk, doctor listen