SYMPTOMATOLOGY

PAIN
Always remember SQITARRS
• Site
• Quality (nature or character)
• Intensity (severity)
• Timing (onset, duration, progression and previous
episodes)
• Aggravating (precipitating) factors
• Relieving factors
• Referral, radiation, and migration
• Secondary (associated) symptoms
 COUGH
• Frequency

• Change of posture aggravates or relieve it

• Productive or dry

• Sputum color (clear, white, or yellowish-green)

• Amount (teaspoon,..etc)

• Associated pink frothy sputum, streak of blood on

mucus, or blood clots (serious: hemoptsis)
 DYSPNOEA
Shortness of breath (breathlessness)

Clssification
1. Orthopnoea (when lying flat)

2. Exertional Dysp. (during exertion or exercise)

3. Paroxysmal nocturnal Dysp. (at night)

DYSPHAGIA
• Difficulty in swallowing

• Intermittent or progressive

• Painful (odynophagia) or painless

• To solid food, to fluidy food, or even to saliva

 WEIGHT LOSS
• How much? and on which period?
• Significant wt loss: more than 10% of body weight in 3
months (serious)

Ask about clothes and wearings if got larger lately e.g.

• Hats
• Socks and shoes
• Clothes
• Rings
•Appetite Has the appetite increased,
decreased, or
•remained the same? If it has decreased, is
this caused
•by a loss of appetite, or is it because of
apprehension
•as eating always causes pain?
 VOMITING
• Quantity or volume (small, moderate, large)
• Frequency (No.)
Both assess magnitude of vomiting

• Quality [contains previous meal, undigested recognizable

food (gastric outlet obstrucyion), clear acidic fluid(reflux
disease)..etc]

• Associated blood : serious factor as in varices, ulcer,

tumour
• The blood is either fresh(hematmesis) or changed
(coffee-ground by action of acid and pepsin)
Colour and taste
may assess level of intestinal obstruction

• Colour of previous meals → IO proximal to second

part of duodenum
• Bile-stained → distal to second part of duodenum
• Feculent → distal ileum
• Faecal → colon
Character
Projectile( in gastric outlet obstruction)

Self-induced (to relieve pain or in alcoholic)

Effortless (multiple causes as infection, IO, etc)

• Relieve pain or not

• Timing : early morning (pregnancy, brain tumors)

• Preceding symptom or factor (e.g. drug, alcohol, surgical

procedure or trauma)

• Associated symptoms (nausea, anorexia, wt loss,

dyspepsia…etc)
•Flatulence
•Does the patient belch frequently?
Does
this relate to any other symptoms?
•Indigestion or abdominal pain
(dyspepsia) This is correctly defined as difficulty in
digesting food and
is usually accompanied by discomfort or abdominal
pain and often by heartburn and belching .
• Some patients call all abdominal pains indigestion;
the difference between a discomfort after eating and
a pain after eating may be very small.
 JAUNDICE
Yellowish discoloration of the skin and eyes (sclera)
• Light yellow(nonobstructive) or deep orange
colour(obstructive)

• Progressive or intermittent

• Painless or painful (in stones or infection)

• Itching, dark-colored urine and pale stools in obstructive

type

• Associated symptoms (loss of appetite, weight loss,

dyspepsia in malignancy,….)
 DEFAECATION
BOWEL HABITS
• Frequency (normally 3 times/day to once in 3 days
• Colour (brown, pale, or black tarry: serious called
melaena)
• Consistency (watery, soft, or solid)
• Amount
• Smell (foully or offensive smell in malabsorption)
• Specific gravity (floating stool or unflushable stool
suggest fat malabsorption)
BOWEL MOTION
• Never use diarrhoea (instead say: loose BM)
• It may referred by the patient to
• Increased frequency than normal
• Watery consistency
• Large amount
• Urgency of defaecation

• Absolute constipation (obstipation) : No passage of stool

and flatus
Bleeding per rectum
Types
Tarry stool called melaena (upper GI bleeding)
Fresh bleeding called haematoschisea

Amount
Frequency

Timing and relation with defaecation

Mixed with stool(higher causes)
Covering stool(anal and rectal causes)
With defaecation or after it
 BLEEDING PER RECTUM
• Bright (haematoshizia), or black tarry (melaena)

• Size and frequency

• With stool or after stool or not related to stool

• Mixed with stool or on the surface of stool

Thank you