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Medical History and Physical Examination for Digestive Disorders

By Walter W. Chan, MD, MPH, Assistant Professor of Medicine, Harvard Medical School; Director, Center for Gastrointestinal Motility, Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital

Usually, a doctor can determine whether a person has a digestive disorder based on the medical history and a physical examination. The doctor can then select appropriate procedures that help to confirm the diagnosis, determine the extent and severity of the disorder, and aid in planning treatment.

Medical History

A doctor identifies symptoms by interviewing a person to obtain the medical history and asking specific questions to gain additional information. For example, in speaking with a person who has abdominal pain, the doctor might first ask, “What is the pain like?” This question might be followed by questions such as, “Does the pain get better after you eat?” or “Does the pain get worse when you bend over?”

Physical Examination

First, the doctor observes the abdomen from different angles, looking for swelling (distention) of the abdominal wall that might accompany abnormal growth or enlargement of an organ. A stethoscope is placed on the abdomen, through which the doctor listens for sounds that normally accompany the movement of material through the intestines and for any abnormal sounds. The doctor feels for tenderness and any abnormal masses or enlarged organs. Pain that is caused by gentle pressure on the abdomen and that is increased when the pressure is released (rebound tenderness) may indicate inflammation and sometimes infection of the lining of the abdominal cavity (peritonitis).

The anus and rectum are examined with a gloved finger, and a small sample of stool is sometimes tested for hidden (occult) blood. In women, a pelvic examination often helps distinguish digestive problems from gynecologic ones.

Psychologic Evaluation

Because the digestive system and the brain are highly interactive (see Mind-Body Interactions), a psychologic evaluation is sometimes needed in the assessment of digestive problems. In such cases, doctors are not implying that the digestive problems are made up or imagined. Rather, the digestive problems may be the result of anxiety, depression, or other treatable mental disorders. Such disorders can affect how active digestive tract contractions are and/or how sensitive people are to these sensations. Psychologic factors seem to play a role in as many as 50% of people with symptoms of a digestive disorder.