6. Gastroenterology: a symptoms based approach Flashcards
What should be asked about abdominal pain when taking a history?
Quality Location Radiation Timing Connection with eating What aggravates and relieves Associated symptoms
Define diarrhoea
Increased frequency (>3) and liquidity of faeces >250g of stool a day
What is the difference between acute, persistent and chronic diarrhoea?
Acute <7 days
Persistent 14-21
Chronic >1 month
What are the characteristics of small bowel diarrhoea?
Watery Large volume Cramping, bloating Gas Weight loss
What are the characteristics of large bowel diarrhoea?
Frequent
Small volume
Blood and mucous
Fever
What are the parameters for severe diarrhoea?
>6 in 24 hours Blood Fever Dehydration Severe abdominal pain
What is tenesmus?
feeling that the bowel is full even after a bowel movement
What effects can chemo and radiotherapy have on the GIT?
Colitis and enteritis
What is fever associated with?
infection
inflammatory
What is weight loss associated with?
Malignancy
Coeliac disease
Crohn’s disease
Pancreatic insufficiency
What symptoms are associated with IBD?
Uveitis
Joint pains
Mouth ulcers
Erythema nodosum
What effects does smoking have on the GIT?
Worsens Crohn’s, malignancy
Protective to ulcerative colitis
What effect does alcohol have on the GIT?
Chronic pancreatitis
Pancreatic insufficiency
What are NSAIDs associated with?
Colitis
What are proton pumps associated with?
c. diff
What should be looked for on examination if a patient presents with diarrhoea?
Dehydration and malnourishment
Mouth ulcers
Rashes
Hepatomegaly, arthritis, anorectal disease
Define constipation
<3 bowel movements per week
What are the causes of constipation?
Lack of fibre, dehydration or exercise Medications Life or routine changes Psychological Neurological and metabolic Diverticulosis, coeliac disease, GI tumours, IBS Hypothyroidism, hypercalcaemia
What complications are associated with constipation?
Haemorrhoids
Anal fissures
Rectal prolapse
Fecal impaction
What treatments can be used for constipation?
Bulk forming agents Osmotic laxatives Stimulant/irritant laxatives Stool softeners Cholinergic agonists
What is odynophagia?
Painful swallowing
What is globus sensation?
Throat tightness
What are the mechanical causes of dysphagaia?
Oesophageal cancer
Peptic stricture
Achalasia
Oesophagitis
What are the neuromuscular causes of dysphagia?
Diffuse oesophageal spasm
CNS causes
Causes of clubbing
IBD
Cirrhosis
Coeliac disease
What causes leuconychia?
Hypoalbuminaemia
What causes koilonychia?
Iron deficiency anaemia
What causes palmar erythema?
Cirrhosis
What causes palmar crease pallor and conjunctival pallor?
Anaemia
What causes Dupytren’s contracture?
Excess alcohol
What causes hepatic flap?
Hepatic encephalopathy
Uraemia
What causes scleral icterus?
Liver disease
What causes xanthelasma?
Hyperlipidaemia
What causes angular stomatitis and tongue glossitis?
Iron/B12 deficiency
Glossitis also folate deficiency
What diseases are associated with mouth ulcers?
Crohn’s
Coeliac disease
What is candidiasis a sign of?
Immunodeficiency
What are spider naevi and gynaecomastia a sign of?
Chronic liver disease
What are the infective causes of hepatomegaly?
Hepatitis
EBV
Malaria
Hepatic abscess
What are the infiltrative causes of hepatomegaly?
Haemochromatosis Wilson's Sarcoid Amyloid Fatty liver
What are the blood related causes of hepatomegaly?
Lymphoma
Leukaemia
Myeloproliferative disorders
Haemolytic anaemia
What are the congestive causes of hepatomegaly?
Right heart failure
Tricuspid regurgitation
Budd Chiari syndrome
What are the causes of splenomegaly?
Malaria
CML
Myelofibrosis
Feltys syndrome
What is Feltys syndrome?
RA
Neutropaenia
Splenomegaly
