1. Principles of Clinical History and Examination
    2. 1. Managing clinical encounters with patients
    2. General aspects of history taking
    3. General aspects of examination
  2. System-based Examination
    3. 4. The cardiovascular system
    5. The respiratory system
    6. The gastrointestinal system
    7. The nervous system
    8. The visual system
    9. The ear, nose and throat
    10. The endocarine system
    11. The reproductive system
    12. The renal system
    13. The musculoskeletal system
    14. The skin, hair and nails
  3. Applying History and Examination skills in Specific Situations
    4. 15. Babies and children
    16. The patient with mental disorder
    17. The frail elederly patient
    18. The deteriorating patient
    19. The dying patient
  4. Putting History and Examination Skills to use
    5. 20. Preparing for assessment
    21. Preparing for practice
System-based Examination
6. The gastrointestinal system
ANATOMY AND PHYSIOLOGY
HISTORY
Common presenting symptoms
Mouth symptoms
▢ Halitosis (Bad breath):
  1. Due to gingival, dental or pharyngeal infection
▢ Xerostomia (Dry mouth):
▢ Dysgeusia (Altered taste sensation):
▢ Cacogeusia (Foul taste in the mouth):
Anorexia
Loss of appetite and/or a lack of interest in food.
Weight loss
Gradual weight loss
▢ Due to reduced energy intake:
  1. Dieting
  2. Anorexia
  3. Malabsorption
  4. Malnutrition
▢ Due to increased energy expenditure:
  1. Hyperthyroidism
  2. Fever
  3. Adoption of a more energetic lifestyle
Rapid weight loss
▢ Initially:
  1. Salt and water loss
  2. Depletion of hepatic glycogen stores
▢ Later:
  1. Loss of body fluid
    1. Vomiting
    2. Diarrhoea
    3. Diuretics
Pain
Painful mouth
▢
  1. Sore lips
  2. Sore tongue
  3. Sore buccal mucosa
▢ Causes:
  1. Deficiencies
    1. Iron
    2. Folate
    3. Vitamin B12
    4. Vitamin C
  2. Dermatologial disorders
    1. Lichen planus
  3. Chemotherapy
  4. Aphthous ulcers
  5. Infective stomatitis
  6. Inflammatory bowel disease with mouth ulcer
  7. Coeliac disease with mouth ulcer
Heartburn and reflux
▢ Site:
▢ Onset:
▢ Progression:
▢ Radiation:
▢ Associated symptoms:
▢ Timing:
▢ Exacerbating factors:
▢ Relieving factors:
▢ Severity:
Dyspepsia (Pain in upper abdomen)
▢ Site:
▢ Onset:
▢ Progression:
▢ Radiation:
▢ Associated symptoms:
▢ Timing:
▢ Exacerbating factors:
▢ Relieving factors:
▢ Severity:
Classification based on Syndromes
Reflux-like dyspepsia
Ulcer-like dyspepsia
Dysmotility-like dyspepsia
Odynophagia (Pain on swallowing)
Abdominal pain
▢ Site:
▢ Onset:
▢ Progression:
▢ Radiation:
▢ Associated symptoms:
▢ Timing:
▢ Exacerbating factors:
▢ Relieving factors:
▢ Severity:
Dysphagia
Nausea and Vomiting
Wind and Flatulence
Abdominal distension
Altered bowel habit
Diarrhoea
Constipation
Bleeding
Haematemesis
Melaena
Rectal bleeding
Jaundice
Pre-hepatic jaundice
Hepatic jaundice
Posthepatic/ cholestatic jaundice
Groin swellings andd Lumps
Past medical history
Drug history
Family history
Social history
THE PHYSICAL EXAMINATION
General examination
PILCOD
▢ Pallor:
▢ Icterus:
▢ Lymphadenopathy:
▢ Cyanosis:
▢ Oedema:
▢ Decubitus:
Abdominal examination
Inspection
Palpation
Percussion
▢ Sound heard:
Tympanic
Resonant
Dullness
Single high pitch
Between Tympanic and Dull
  1. Low pitched
  2. Barely heard
In abdomen
In Chest wall
In muscles
Ascites
Shifting dullness
Fluid thrill
Shifting dullness
Fluid thrill
Auscultation
Hernias
Rectal examination
Proctoscopy
INVESTIGATIONS