The Review of Systems

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Introduction

  • ARE more than just a routine set of questions
  • The assist in narrowing down which organ or organ system is being affected
  • In combination with the chronology it helps suggests the disease process involved
  • It is a trigger to identify related or unaddressed issues to the patient’s complaint
  • They need to be explored just as with any symptom e.g. severity, chronology

CONSTITUTIONAL SYMPTOMS

SYMPTOM DISEASE PROCESS
Fever Infection
Neoplasm
Chronic inflammation
Toxicological
Weight loss Chronic Infection
Chronic inflammation
Neoplastic
Metabolic-Endocrine

LOCALISING PAIN SYMPTOMS

  • Pain usually suggests an inflammatory process or a rapidly expanding lesion in a contained space
SITE OF PAIN ORGAN
Headache Head, Eyes, ENT, Oral-Dental, Nekc
Chest pain Heart, Lungs, Upper GIT
Upper abdominal pain Foregut – Upper GIT, Hepato-biliary-pancratic, Spleen
Heart
Lower abdominal pain Hindgut – colon, rectum
Back pain
Spine
Retroperitoneum
Extremity pain Muscle / Tendon
Bone
Nerve – e.g. neuralgic/referred apin
Vessel e.g. ischaemia
Joint Pain Bone
Cartilage
Capsule
Ligament
Tendon

LOCALISING BLEEDING SYMPTOMS

  • Also consider a disorder of clotting as the cause of localised bleeding
  • Neoplasm should be always considered in recurrent, spontaenous bleeding
  • Post-operative bleeding is due to surgical trauma (if immediate) and infection (if later)
SITE OF BLEEDING ORGAN LOCATION
Haemoptypsis Upper and lower respiratory tract
Haematemesis Upper GI tract
(also consider upper respiratory tract bleeding that has been swallowed and vomited)
Malaena Upper GI tract
PR bleeding / Haematochezia Lower GI tract
Haematuria Upper and lower urinary tract
Lower genital tract
Vaginal bleeding Genital tract

 

 

SYMPTOMS OF ORGAN DYSFUNCTION

Symptom Organ function
Palpitations Cardiac electrical
Dyspnoea Cardiac mechanical
Respiratory
Neuromuscular
Faints CVS
Dysphagia / Regurgitation Oral-pharyngeal
Upper GIT
Neuromuscular
Diarrhoea / Staetorrhea Lower GIT
Urinary retention / incontinence / Hesitancy Urinary tract
Jaundice Hepato-biliary
Fits and Funny turns CNS
Weakness / Sensory change Neurological

SPECIFIC SYMPTOMS OF INFLAMMATION

Symptom Organ location
Sore mouth / Toothache Oral-Dental
Sore throat  Oral-pharynx
Odynophagia Oral-pharynx
Upper GIT
Dysuria / Urgency Genito-urinary tract
 Vaginal Discharge / Dyspareunia  Genital tract

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