1 .GASTROINTESTINAL SYSTEM
Name:
Age:
Address:
Occupation:
CHIEF COMPLAINTS:
Abdominal Pain
Abdominal distention
Abdominal Lump
Dysphagia
Flatulence
Vomitings / Nausea
Haemetemesis / Diarrhoea / Malena
Jaundice / Fever / Edema / Oliguria / Burning Sensation
HISTORY OF PRESENT ILLNESS :
Abdominal pain:
Duration / onset / progress / site / type / episodes / lasting radiation /
aggrevating factors / relieving factors
Abdominal Distention:
Duration / onset / progress / associated pain / urineoutput / pedal edema /
puffiness of face / vomiting / aggrevating factors / relieving factors
,Abdominal Lump:
Duration / onset / progress / site / size / surface / skin over the lump / edges
/ associated with pain
Dysphagia:
Duration / onset / progress / relation with solids and liquids / aggrevating
factors / relieving factors
Flatulence :
History of habit of belching / duration / pain / presence of diarrhea /
ingestion of certain type of food / history of food allergy / intestinal parasite.
Vomiting:
amount, colour, bilious or not, blood stained, food particles, foul smelling
Duration / onset / progress / episodes / associated with nausea / projectile /
aggrevating factors / relieving factors
Jaundice:
Duration / onset / progress / aggrevating factors / relieving factors
Hemetemesis:
Duration / onset / progress / episodes / timing / colour / aggrevating factors
/ relieving factors
Diarrhoea:
Amount, colour, blood stained, mucous stained,watery or semisolid,
tenesmus, foul smelling, associated with pain
Duration / onset / progress / episodes / timing / aggravating factors /
relieving factors
,Malaena:
Duration / onset / progress / episodes / associated with straining / sticking
to pan
Fever:
Duration / onset / progress / episodes / grades / associated with chills and
rigors / associated with night sweats / aggravating factors / relieving factors
Oedema:
Duration / onset / progress / site / type(pitting or non pitting) / aggravating
factors / relieving factors
Oliguria:
Duration / onset / progress / daily amount / urine colour / dysuria /hematuria
/ aggravating factors / relieving factors
Burning Sensation:
Duration / onset / progress / aggravating factors / relieving factors
PAST HISTORY :
Similar history in the past
H/O TB / DM / HTN / Jaundice / Bronchial Asthma / Epilepsy
H/O Blood Transfusion
H/O Any Drug Intake
PERSONAL HISTORY :
Diet
H/O Loss of weight and Loss of Appetite
Bowel and Bladder habits
Sleep Disturbances
, Habits-Smoking / Alcohol
H/O Any exposure and travel to Endemic areas
FAMILY HISTORY :
Similar history in family or in surroundings
Family history of TB / HTN / DM / Bronchial Asthma
MENSTRUAL HISTORY :
Menarche / LMP
Menstrual cycle(regular or not/associated with pain or not)
DRUG HISTORY :
Allergy to any drugs
GENERAL EXAMINATION :
Conscious /oriented /cooperative
Built / Nourishment – Skin fold thickness ,Mid arm circumference, waist –
hip ratio
Pallor / Icterus / Cyanosis / Clubbing
Edema / Lymphadenopathy
SIGNS OF LIVER FAILURE ;
Alopecia / Icterus / Parotid Gland Enlargement / Spider naevi /
Gynaecomastia / Ascites / Testicular atrophy / Palmar Erythema / White
Nails / Clubbing / Flapping Tremors / Duputyrens Contracture
Name:
Age:
Address:
Occupation:
CHIEF COMPLAINTS:
Abdominal Pain
Abdominal distention
Abdominal Lump
Dysphagia
Flatulence
Vomitings / Nausea
Haemetemesis / Diarrhoea / Malena
Jaundice / Fever / Edema / Oliguria / Burning Sensation
HISTORY OF PRESENT ILLNESS :
Abdominal pain:
Duration / onset / progress / site / type / episodes / lasting radiation /
aggrevating factors / relieving factors
Abdominal Distention:
Duration / onset / progress / associated pain / urineoutput / pedal edema /
puffiness of face / vomiting / aggrevating factors / relieving factors
,Abdominal Lump:
Duration / onset / progress / site / size / surface / skin over the lump / edges
/ associated with pain
Dysphagia:
Duration / onset / progress / relation with solids and liquids / aggrevating
factors / relieving factors
Flatulence :
History of habit of belching / duration / pain / presence of diarrhea /
ingestion of certain type of food / history of food allergy / intestinal parasite.
Vomiting:
amount, colour, bilious or not, blood stained, food particles, foul smelling
Duration / onset / progress / episodes / associated with nausea / projectile /
aggrevating factors / relieving factors
Jaundice:
Duration / onset / progress / aggrevating factors / relieving factors
Hemetemesis:
Duration / onset / progress / episodes / timing / colour / aggrevating factors
/ relieving factors
Diarrhoea:
Amount, colour, blood stained, mucous stained,watery or semisolid,
tenesmus, foul smelling, associated with pain
Duration / onset / progress / episodes / timing / aggravating factors /
relieving factors
,Malaena:
Duration / onset / progress / episodes / associated with straining / sticking
to pan
Fever:
Duration / onset / progress / episodes / grades / associated with chills and
rigors / associated with night sweats / aggravating factors / relieving factors
Oedema:
Duration / onset / progress / site / type(pitting or non pitting) / aggravating
factors / relieving factors
Oliguria:
Duration / onset / progress / daily amount / urine colour / dysuria /hematuria
/ aggravating factors / relieving factors
Burning Sensation:
Duration / onset / progress / aggravating factors / relieving factors
PAST HISTORY :
Similar history in the past
H/O TB / DM / HTN / Jaundice / Bronchial Asthma / Epilepsy
H/O Blood Transfusion
H/O Any Drug Intake
PERSONAL HISTORY :
Diet
H/O Loss of weight and Loss of Appetite
Bowel and Bladder habits
Sleep Disturbances
, Habits-Smoking / Alcohol
H/O Any exposure and travel to Endemic areas
FAMILY HISTORY :
Similar history in family or in surroundings
Family history of TB / HTN / DM / Bronchial Asthma
MENSTRUAL HISTORY :
Menarche / LMP
Menstrual cycle(regular or not/associated with pain or not)
DRUG HISTORY :
Allergy to any drugs
GENERAL EXAMINATION :
Conscious /oriented /cooperative
Built / Nourishment – Skin fold thickness ,Mid arm circumference, waist –
hip ratio
Pallor / Icterus / Cyanosis / Clubbing
Edema / Lymphadenopathy
SIGNS OF LIVER FAILURE ;
Alopecia / Icterus / Parotid Gland Enlargement / Spider naevi /
Gynaecomastia / Ascites / Testicular atrophy / Palmar Erythema / White
Nails / Clubbing / Flapping Tremors / Duputyrens Contracture
