You are seeing Mr. Martin, a 58 year old male, in the ER for a one-week history of dark stools. Take a focused history of his complaint.
History
- Onset of symptom
- Change in bowel habit
- Appearance of stool – distinguishes melena from bright red blood per rectum
- Association with bowel movements
- Tenesmus
- Incomplete voiding
- Pain on defecation
- Abdominal pain
- Dyspepsia
- Symptoms of reflux
- Nausea and vomiting
- Systemic symptoms, especially weight loss
- Personal history of constipation and/or hemorrhoids
- Personal history of gastrointestinal ulcers
- Country of origin (risk factor for H. Pylori infection)
- NSAID use
- Smoking history (quantity in pack-years)
- Alcohol use
- Hepatitis status
- Past colonoscopy and upper endoscopy
- Family history of gastrointestinal cancers
Case 2 – GI Bleeding