<?xml version="1.0" encoding="UTF-8"?>
<opml version="2.0">
  <head>
    <title>049-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Gastrointestinal assessment foundations">
      <outline text="Orientation">
        <outline text="Symptoms converted into an anatomical, physiological model"/>
        <outline text="Urgency judged at the bedside simultaneously"/>
        <outline text="Each symptom spans benign to malignant causes"/>
        <outline text="Safest approach">
          <outline text="Define onset and trajectory"/>
          <outline text="Localise the likely compartment"/>
          <outline text="Assess hydration and perfusion"/>
          <outline text="Search for peritonitis or obstruction"/>
          <outline text="Tests answer explicit questions"/>
        </outline>
      </outline>
      <outline text="Symptom history">
        <outline text="Pain: onset, site, radiation, character, colic">
          <outline text="Visceral pain diffuse, midline via shared afferents"/>
          <outline text="Parietal inflammation: sharp local pain, guarding"/>
          <outline text="Migration informative but patterns imperfect"/>
          <outline text="Sudden maximal pain needs urgent evaluation"/>
        </outline>
        <outline text="Vomiting: volume, colour, bile, blood, faeculent">
          <outline text="Repeated vomiting loses chloride and hydrogen">
            <outline text="Contraction alkalosis, low potassium, kidney injury"/>
          </outline>
          <outline text="Faeculent: distal obstruction or fistula"/>
          <outline text="Distinguish regurgitation and rumination"/>
        </outline>
        <outline text="Dysphagia: initiation, solids, liquids, progression"/>
        <outline text="Dyspepsia is a symptom cluster, not a diagnosis"/>
        <outline text="Bowel habit: baseline, blood, nocturnal, steatorrhoea">
          <outline text="Coating versus mixed blood cannot exclude proximal disease"/>
          <outline text="Iron and bismuth darken stool without bleeding"/>
        </outline>
        <outline text="Jaundice: urine, stool, pruritus, exposures">
          <outline text="Ask chronic liver features when possible"/>
        </outline>
      </outline>
      <outline text="Context and risk">
        <outline text="Surgery, hernias, bowel disease, cancer, pregnancy"/>
        <outline text="Prior surgery raises adhesion risk, not proof"/>
        <outline text="Medicines cause ulcer, bleeding, dysmotility">
          <outline text="Review anti-inflammatories, antithrombotics, opioids"/>
        </outline>
        <outline text="Diet asked neutrally and specifically"/>
        <outline text="Family history: cancers, polyposis, inflammatory"/>
        <outline text="Social: sanitation, travel, housing, stoma care"/>
      </outline>
      <outline text="Immediate physiological assessment">
        <outline text="Airway risk from haematemesis or low consciousness"/>
        <outline text="Breathing, pulse, pressure, refill, mental state"/>
        <outline text="Seek shock, sepsis, bleeding, perforation, obstruction"/>
        <outline text="Normal early haemoglobin does not exclude major loss">
          <outline text="Plasma and red cells lost together"/>
        </outline>
      </outline>
      <outline text="General and abdominal examination">
        <outline text="Observe distress, wasting, pallor, jaundice"/>
        <outline text="Hands: clubbing, erythema, asterixis"/>
        <outline text="Chronic liver signs support context only"/>
        <outline text="Expose chest to groin with dignity"/>
        <outline text="Bowel sounds have limited accuracy"/>
        <outline text="Gentle palpation away from pain, watch face">
          <outline text="Voluntary guarding versus involuntary rigidity"/>
          <outline text="Rebound unneeded if irritation already shown"/>
          <outline text="Never press a suspected aneurysm forcefully"/>
        </outline>
        <outline text="Shifting dullness less sensitive than ultrasound"/>
        <outline text="Rectal examination only when it changes care"/>
        <outline text="Examine beyond the abdomen"/>
      </outline>
      <outline text="Baseline investigations">
        <outline text="Tests follow the syndrome"/>
        <outline text="Blood count, electrolytes, gas, liver tests"/>
        <outline text="Interpret trends and pretest probability">
          <outline text="Normal lactate misses early mesenteric ischaemia"/>
          <outline text="Mild lipase rise occurs outside pancreatitis"/>
          <outline text="Occult blood does not localise bleeding"/>
        </outline>
        <outline text="Stool tests for inflammatory, outbreak, travel cases"/>
      </outline>
      <outline text="Imaging and endoscopy">
        <outline text="Plain films: limited indications"/>
        <outline text="Negative erect chest film allows perforation"/>
        <outline text="Ultrasound for gallstones, biliary tree, ascites"/>
        <outline text="Computed tomography for obstruction, perforation"/>
        <outline text="Urgent angiography for bleeding or ischaemia"/>
        <outline text="Endoscopy sees, biopsies and treats">
          <outline text="Capsule may be retained at strictures"/>
          <outline text="Retrograde study mainly therapeutic"/>
        </outline>
      </outline>
      <outline text="Acute pain and surgical consultation">
        <outline text="Resuscitation and diagnosis proceed together"/>
        <outline text="Analgesia with repeated examination hides little"/>
        <outline text="Early surgery for time-sensitive disease"/>
        <outline text="Immediate escalation list">
          <outline text="Peritonism, free gas, strangulation, ischaemia"/>
          <outline text="Ruptured aneurysm, ectopic pregnancy, torsion"/>
        </outline>
        <outline text="Muted signs in frail, pregnant, immunosuppressed"/>
        <outline text="Reassessment after treatment is diagnosis"/>
      </outline>
    </outline>
  </body>
</opml>
