A, medical history collection (mainly common symptoms of gastroenterology)

1. diet: whether you have hunger or anorexia. Whether there is fullness, belching, acid regurgitation after eating, whether there is weight loss, and what is the relationship between eating and abdominal pain, bloating and vomiting.

2. Dysphagia: onset, occurrence and duration, reaction to swallowing fruit juice and solid food, progressive aggravation or intermittent occurrence, and whether the part with conscious dysphagia is accompanied by esophageal (retrosternal) pain.

3. Abdominal pain: acute or chronic, how long it takes, location, nature and degree, whether there is rhythmic, periodic, radioactive pain, paroxysmal or persistent pain, relieving factors, whether it is accompanied by belching and acid regurgitation, the relationship between pain and defecation, and whether there is metastasis of abdominal pain.

Example: (1) acute pancreatitis: acute onset, epigastric pain, knife-like pain, persistent and slow flexion.

Solution, can have jaundice.

(2) Duodenal ulcer: chronic, epigastric, dull pain, rhythmic (hunger pain), which can be relieved after eating, intermittent pain, accompanied by belching and acid regurgitation.

4. Nausea and vomiting: the nature, quantity, frequency, color and smell of vomit, whether it is mixed with food, the relationship between occurrence time, inducement and degree and eating, whether it is accompanied by headache, jet vomiting, dizziness, abdominal pain, constipation, fever and disturbance of consciousness.

Example: Pyloric obstruction: The vomit mixed with liquid is about 300ml, which is sour, mixed with overnight food, no grass green liquid, no headache, no jet vomiting and no dizziness.

5. Hematemesis and black stool: quantity, frequency and color, the relationship between blood in stool and feces (whether blood and feces are mixed), and whether there are any accompanying symptoms, such as abdominal pain, diarrhea, vomiting, fever, anemia or shock.

Example: (1) hematemesis: vomit brown liquid, about 200ml, * * * three times, mixed with a small amount of food residue.

(2) Blood in the stool: blood drops after defecation, blood on the surface of stool, and blood mixed with stool.

6. Abdominal mass: the time of discovery and development, the shape, size, activity, tenderness or pain of the mass, abnormal defecation (such as constipation) and fever.

Example: A mass in the upper abdomen was found two months ago, such as the size of an egg, poor mobility and no tenderness. Now the mass is bigger than before, about 5x6x2cm 3.

7. Jaundice: the occurrence of urgency, whether it is aggravated progressively, whether it is accompanied by itchy skin, fatigue, vomiting, loss of appetite, whether the color of defecation has changed, and whether there is fever.

Example: (1) Six months ago, the skin and eyes gradually turned yellow, and the skin was itchy, weak and had no abdominal pain.

Vomiting, anorexia, yellow urine, no obvious cold and heat, no obvious white mud and stool, the above symptoms are gradually aggravated with weight loss.

(2) Before February, the skin and urine began to appear yellow and golden yellow, without itching, fatigue and anorexia.

Have aversion to oil, nausea and vomiting.

8. defecation: whether there is diarrhea or constipation, how long it takes (acute or chronic), the number of defecations every day, and the feces when diarrhea occurs.

It is watery, mushy, mucinous or purulent stool with or without diarrhea and constipation, accompanied by abdominal pain and fever. Example: Two hours ago, yellow watery stool suddenly appeared for more than ten times, and there was no purulent blood and peptone, no urgency in urination, accompanied by paroxysmal colic around the umbilicus, and I was consciously afraid of cold and fever.

9. Abdominal distension, oliguria, edema of both lower limbs: onset time, development, urine volume, degree of edema of both lower limbs, whether accompanied by chest tightness, shortness of breath, urine foam, low fever, night sweats, progressive emaciation, facial edema, aversion to oil, anorexia, joint pain, rash and jaundice.

Example: I began to feel abdominal distension before March, and my abdomen gradually bulged. At the same time, my urine output decreased to 1 0,000ml/day, and my lower limbs were slightly swollen. The above symptoms are getting worse, the skin and eyes turn yellow, the face is swollen and there are no bubbles.

Foam urine.

2. Past history, personal history and family history closely related to digestive system diseases.

1. History of hepatitis (what kind), schistosomiasis, hepatobiliary diseases and gastrointestinal diseases.

2. Is there any history of abdominal surgery and postoperative conditions?

3. Degree and years of tobacco and alcohol hobbies

4. Is there a history of tumor, hereditary disease, hepatitis and other similar diseases and infectious diseases in the family?

Example: (1) Hepatitis B->; Liver cirrhosis after hepatitis->; liver cancer

(2) drinking->; Alcoholic liver disease

(3) Peptic ulcer > distant ulcer

(4) cholecystitis and gallstones->; pancreatitis

(5) history of abdominal surgery->; intestinal adhesion

(6) after cholecystectomy->; Residual stones, post-cholecystectomy syndrome.

Third, the main points of physical examination in gastroenterology

1. Nutritional status: whether there is emaciation or weight loss.

2. Skin mucosa: yellow staining, pigmentation, complexion, telangiectasia, spider nevus, liver palm and abdomen.

Superficial varicose veins

3. There is liver odor, supraclavicular lymph node enlargement and male breast development.

4. Abdomen:

Visual diagnosis: Abdominal appearance (swelling, frog abdomen, etc. ), abdominal skin, abdominal varicose veins (exposure |, varicose veins), gastrointestinal type, peristalsis wave, whether there is abdominal breathing.

Palpation: abdominal muscle tension, tenderness and rebound pain, liquid wave tremor.

Liver and spleen: size, texture, margin, tenderness

Quality: location, size, texture, surface condition, boundary, softness and fluidity.

Percussion: liver dullness, percussion pain in liver area, and dullness in abdominal movement.

Auscultation: bowel sounds (disappearing, hyperactivity, tone), vibrating water sounds in the stomach area, and presence of vascular murmurs.

5. Anal digital diagnosis: hemorrhoids, anal fissure, anal fistula, whether the inner wall of anal canal is unobstructed, whether there is a lump, and whether the finger cuff is stained with blood.

Fourth, diagnosis

In order to improve the diagnostic coincidence rate, those who are not completely diagnosed can be written as "to be investigated":

Such as: (1) Abdominal pain to be investigated (1) Cholecystitis and gallstones (2) Acute pancreatitis?

(2) Upper gastrointestinal bleeding: (1) Peptic ulcer (2) Gastric cancer? (3)xxxxx？