Gastrointestinal symptoms are often described with vague words such as “stomach pain,” “indigestion,” or “gas.” These expressions may refer to very different disorders.
The goal is to identify the exact symptom, location, timeline, triggers, associated manifestations, alarm features, and functional impact.
Clarify Abdominal Pain
Begin with:
- “Can you point to where the pain is?”
- “Did it begin suddenly or gradually?”
- “Is it constant or intermittent?”
- “How long does each episode last?”
- “Is it related to meals?”
- “Does it move or radiate anywhere?”
- “What makes it better or worse?”
- “Have you experienced this before?”
Useful descriptions include:
- Cramping
- Burning
- Sharp
- Dull
- Colicky
- Gnawing
- Pressure-like
Colicky pain generally describes pain that rises and falls in waves.
Avoid documenting “stomach pain” when the patient is describing pain elsewhere in the abdomen.
Ask About Nausea And Vomiting
Ask:
- “How many times have you vomited?”
- “Are you able to keep fluids down?”
- “What did the vomit look like?”
- “Was there blood in it?”
- “Did it look like coffee grounds?”
- “Was it green or yellow?”
- “Did the vomiting begin before or after the pain?”
Important terms include:
Hematemesis: vomiting blood.
Coffee-ground emesis: dark granular material representing partially digested blood.
Bilious vomiting: vomiting bile-containing green or yellow material.
Do not translate “vomitei sangue” as “I vomited with blood.” Say, “I vomited blood.”
Clarify Gastrointestinal Bleeding
Ask:
- “Were the stools black and sticky?”
- “Was the blood bright red or dark?”
- “Was it mixed with the stool or only on the paper?”
- “Did you feel dizzy or faint?”
- “Have you used aspirin, anti-inflammatory medication, anticoagulants, or alcohol?”
- “Have you had gastrointestinal bleeding before?”
Useful terms:
Melena: black, tarry stool usually caused by digested blood.
Hematochezia: passage of bright red or maroon blood through the rectum.
Occult bleeding: blood loss not visibly apparent.
Patients may use the word “dark” for brown stool. Ask whether it was truly black, sticky, and tar-like.
Ask About Swallowing
Distinguish:
Dysphagia: difficulty swallowing.
Odynophagia: pain when swallowing.
Globus sensation: sensation of a lump in the throat without a true obstructive swallowing problem.
Ask:
- “Do you have difficulty swallowing solids, liquids, or both?”
- “Does food feel stuck?”
- “Where does it feel stuck?”
- “Has the problem become progressively worse?”
- “Is swallowing painful?”
- “Have you lost weight?”
Progressive dysphagia, weight loss, bleeding, anemia, or persistent vomiting may represent alarm features requiring further evaluation.
Clarify Reflux Symptoms
Ask:
- “Do you experience a burning sensation behind your breastbone?”
- “Do you have a sour or bitter taste in your mouth?”
- “Do symptoms worsen after meals or when lying down?”
- “Do you have nighttime symptoms?”
- “Have you tried any medication?”
Heartburn describes retrosternal burning. It does not mean that the heart itself is burning or that the patient necessarily has cardiac disease.
Chest discomfort still requires appropriate consideration of cardiovascular causes.
Describe Bowel Habits
Ask:
- “How often do you usually have a bowel movement?”
- “Has the frequency changed?”
- “Has the consistency changed?”
- “Do you have to strain?”
- “Do you feel that you cannot empty completely?”
- “Do you have urgency?”
- “Do you wake up at night to have a bowel movement?”
- “Have you noticed mucus or blood?”
Avoid assuming that “normal” has the same meaning for every patient. Establish the patient’s baseline.
Discuss Diarrhea Precisely
Ask:
- “How many bowel movements do you have per day?”
- “Are the stools watery?”
- “Is there blood or mucus?”
- “Have you had fever or abdominal pain?”
- “Have you taken antibiotics recently?”
- “Have you traveled?”
- “Has anyone around you had similar symptoms?”
- “Are symptoms related to particular foods?”
Distinguish increased stool frequency from truly loose or watery stool.
Discuss Constipation Precisely
Constipation may involve:
- Infrequent bowel movements
- Hard stools
- Straining
- Incomplete evacuation
- Sensation of obstruction
- Need for manual maneuvers
Ask about medications, fluid intake, diet, mobility, neurologic disease, and duration of symptoms.
Ask About Liver-Related Symptoms
Useful questions include:
- “Have you noticed yellowing of your eyes or skin?”
- “Has your urine become dark?”
- “Have your stools become pale?”
- “Have you experienced itching?”
- “Have you noticed abdominal swelling?”
- “Have you felt confused or unusually sleepy?”
- “How much alcohol do you drink?”
- “Do you take herbal supplements?”
Important terms include:
- Jaundice
- Pruritus
- Ascites
- Encephalopathy
- Dark urine
- Pale or clay-colored stool
Frequent Errors By Portuguese Speakers
Instead of “I have pain in the stomach,” say:
- “I have abdominal pain.”
- “I have pain in the upper abdomen.”
Instead of “I am with diarrhea,” say:
- “I have diarrhea.”
Instead of “I evacuated blood,” say:
- “I passed blood in my stool.”
- “I had a bloody bowel movement.”
Instead of “My intestine is arrested,” say:
- “I am constipated.”
- “I have constipation.”
Instead of “I have reflux,” when describing a symptom, say:
- “I have heartburn.”
- “I experience acid regurgitation.”
Conclusion
A clear gastrointestinal history depends on four principles:
- Replace vague words with precise symptoms.
- Establish location and chronology.
- Characterize bleeding, swallowing, and bowel habits carefully.
- Identify alarm features and clinical instability.
The best medical English is the language that helps the clinician understand exactly what the patient is experiencing.
References
- Laine L, et al. ACG Clinical Guideline: Upper Gastrointestinal And Ulcer Bleeding. American Journal of Gastroenterology. 2021.
- Kwo PY, et al. ACG Clinical Guideline: Evaluation Of Abnormal Liver Chemistries. American Journal of Gastroenterology. 2017.