Block 3 - GIT Flashcards
What are 10 common GIT complaints?
- Abdominal pain
- Change in appetite
- Unintentional weight gain or loss
- Nausea or vomiting
- Indigestion/heartburn
- Dysphagia (difficulty in swallowing)
- Change in bowel motions
- Haematemesis (vomiting blood)
- Jaundice (yellowish tinge to eyes and skin)
- Pain on distension
14 Red flags in acute abdominal pain?
Gastrointestinal History Protocol? (8)
Gastrointestinal History Protocol
1. Introduction
2. Presenting Symptoms & HxPC
3. Past Medical History
4. Treatment/Medications
5. Allergies
6. Social History
7. Family History
8. ROS
What questions should you ask about a patient’s past medical history in a Gastrointestinal History? (5)
GIT History - Past Medical History
1. Previous episodes of the same?
2. Surgical history?
3. Inflammatory bowel disease?
4. Gastro-oesophageal reflux?
5. Any history of endoscopy, colonoscopy - reason, results?
What questions should you ask about a patient’s medications/treatments in a Gastrointestinal History? (5)
GIT History - Treatment/Medications
1. Prescribed?
2. OTC?
3. Herbal?
4. NSAIDs - possible pain/bleeding?
5. Drugs affecting the liver - steroids? alcohol? paracetamol?
What questions should you ask about a patient’s social history in a Gastrointestinal History? (6)
GIT History - Social History
1. Occupation
2. Recent travel
3. Smoking
4. Alcohol
5. Illicit drugs
6. Risk factors for blood-borne diseases, particularly Hepatitis C – sexual history, tattoos, shared needles, known contacts
What questions should you ask about a patient’s family history in a Gastrointestinal History? (7)
GIT History - Family History
1. GI malignancy (age of onset)
2. Inflammatory bowel disease
3. Autoimmune disease
4. Jaundice
5. Anaemia
6. Splenectomy
7. Cholecystectomy
Which specific questions should you ask for a patient presenting with abdominal pain? (7)
Abdominal Pain: SOCRATES
1. Elicit pain history including frequency and duration: Acute or chronic
2. When and how often
3. Site – ask patient to point to site.
4. Radiation
5. Pattern of pain: colicky or constant
6. Aggravating and relieving factors.
7. Associated symptoms - bowels & urine? vomit? women - periods? sexual activity?
6 Common causes of unintentional weight loss?
** GIT History - Unintentional weight gain or loss**
1. Malabsorption
2. Malignancy
3. Thyroid disease
4. Inflammatory bowel disease
5. Eating disorders
6. Depression
6 Common causes of unintentional weight loss?
** GIT History - Unintentional weight gain or loss**
1. Malabsorption
2. Malignancy
3. Thyroid disease
4. Inflammatory bowel disease
5. Eating disorders
6. Depression
11 QUESTIONS TO ASK A PATIENT PRESENTING WITH RECURRENT VOMITING?
**GIT History **
Nausea and/or vomiting: timing, frequency, aggravating and relieving factors
8 QUESTIONS TO ASK THE PATIENT WITH ACID REFLUX OR SUSPECTED GASTRO-OESOPHAGEAL REFLUX DISEASE (GORD)?
9 QUESTIONS TO ASK A PATIENT WHO
REPORTS DIFFICULTY SWALLOWING (DYSPHAGIA)?
Differentials for Dysphagia?
17 QUESTIONS TO ASK THE PATIENT PRESENTING WITH DIARRHOEA?
13 QUESTIONS TO ASK A PATIENT
PRESENTING WITH CONSTIPATION?
7 QUESTIONS TO ASK THE PATIENT WHO PRESENTS WITH VOMITING BLOOD (HAEMATEMESIS)?
19 QUESTIONS TO ASK THE PATIENT PRESENTING WITH JAUNDICE?
Jaundice, dark urine, pale stools, pruritis?
Gastrointestinal Exam Protocol? (10)
Gastrointestinal Exam Protocol
1. Introduction
2. Exposure and Positioning
3. General Inspection
4. Hands - Nails, Palms, Asterixis
5. Arms
6. Face - Eyes, Salivary glands, Mouth
7. Neck & Chest - Inspection, Palpation
8. Abdomen - IPPA
9. Groin
10. Other - Rectal examination, vital signs, urinalysis
GIT Exam - Introduction? (4)
GIT Exam - Introduction
1. Introduces Self
2. Washes hands
3. Explains procedure & gains consent
4. Confirms name & age
“Hi my name is Kitty and i’m a second year medical student. I’ve been asked to come and examine you for any possible gastrointestinal problems. This will involve me having a look at your hands, arms, face, neck and chest then a quick look, listen and feel of your adbomen. Does this all sound ok? Before we get started please can I confirm your name and age? Are you in any pain or is there anything I can get to make you more comfortable?”
GIT Exam - Exposure and Positioning?
GIT Exam - Exposure and Positioning
Lying flat with head on one pillow, expose chest and abdomen
GIT Exam - General Inspection? (6)
GIT Exam - General Inspection
1. Jaundice - hyperbilirubinaemia (prehepatic/hepatic/post-hepatic= obstructive)
2. Body habitus – weight
3. Cachexia/wasting = malabsorption/malignancy/ alcoholic cirrhosis
4. Skin lesions - pigmentation - haemochromatosis, acanthosis nigricans
5. Mental state
6. Vomitus bags or stool sample pots
GIT Exam - Hands? (6)
GIT Exam - Hands
1. Leuconychia = hypoalbuminaemia (chronic liver disease)
2. Clubbing = cirrhosis
3. Palmar Erythema = chronic liver disease
4. Palmar crease pallor - anaemia (GIT bleed, malabsorption)
5. Dupytren’s contracture = permanent flexion = alcoholism BUT not specific
6. Asterixis - liver flap
GIT Exam - Arms? (5)
GIT Exam - Arms
1. Bruising, petechiae = hepatic disease and reduced clotting factor production
2. Muscle wasting
3. Scratch marks = excoriations = obstructive or cholestatic jaundice
4. Spider naevi = alcoholic cirhhosis, viral hepatitis, pregnancy (estrogen excess)
5. Axillary lymphadenopathy
GIT Exam - Face? (12)
GIT Exam - Face
1. Eyes - Sclera icterus
2. Eyes - conjuctival pallor (anaemia)
3. Eyes - xanthalesma
4. Eyes - Kayser–Fleischer ring = Wilson’s disease
4. Face - periorbital purpura = amyloidosis
5. Salivary glands: Palpate parotids and submandibular gland.
6. Mouth: Inspect teeth and gums, breath - fetor
7. Tongue: Geographic tongue = riboflavin (vitamin B2) deficiency.
8. Tongue: Glossitis
9. Tongue: macroglossia
10. Mouth: Aphthous ulcers
11. Mouth: Angular stomatitis
12. Mouth: Oral candidiasis
Causes of Parotid enlargement - 6 Bilateral? 3 Unilateral?
5 causes of gum hypertrophy?
5 CAUSES OF PIGMENTED LESIONS IN THE MOUTH?
8 CAUSES OF FETOR (BAD BREATH)?
Causes of leukoplakia?
**Leukoplakia = premalignant lesion
**
Most of the causes of leucoplakia begin with ‘S’: sore teeth (poor dental hygiene), smoking, spirits, sepsis or syphilis, but often no cause is apparent. Leucoplakia may also occur on the larynx, anus and vulva.
Causes of mouth ulcers?
GIT Exam - Neck & Chest? (4)
GIT Exam - Neck & Chest
1. Spider naevi
2. Gynaecomastia
3. Palpate: Cervical lymph nodes
4. Palpate: Supra-clavicular nodes “shrug your shoulders for me”
A large left supraclavicular node (Virchow’s node) in combination with carcinoma of the stomach is called Troisier’s sign.
GIT Exam - Abdomen - Inspection? (10)
GIT Exam - Abdomen - Inspection
1. Scars
2. Distension - get down to eye level
3. Local swellings
4. Hernia
5. Distended veins - caput medusa (severe portal hypertension)
6. Pulsations
7. Visible peristalsis = normal or intestinal obstruction
8. Skin lesions
9. Striae
10. Movement of the abdominal wall
5 causes of hepatosplenomegaly?
GIT Exam - Abdomen - Palpation? (9 regions)
GIT Exam - Abdomen - Palpation
ASK ABOUT PAIN
Light palpation of all regions followed by deep palpation, tender area palpated last:
1. Right hypochondrium
2. Epigastrium
3. Left hypochondrium
4. Right lumbar region
5. Umbilical region
6. Left lumbar region
7. Right iliac fossa
8. Hypogastrium
9. Left iliac fossa
Rebound tenderness = palpate deeply slowly and lift off quickly.
“On palpation, there was no guarding, rigidity, rebound tenderness, hepatomegaly or splenomegaly.”
GIT Exam - Abdomen - Percussion? (3)
GIT Exam - Abdomen - Percussion
1. borders of the liver
2. borders of the spleen, bladder
3. shifting dullness (ascites)
GIT Exam - Abdomen - Auscultation? (4)
GIT Exam - Abdomen - Auscultation
1. Bowel sounds
2. Epigastric bruits
3. Renal bruits
4. Aorto-Ilio-Femoral bruits
GIT Exam - Abdomen - Groin? (4)
GIT Exam - Abdomen - Groin
1. Inspect hernia orifices (upon standing)
2. Palpate inguinal lymph nodes
3. Palpate testes
DIFFERENTIAL DIAGNOSIS OF A SOLITARY GROIN LUMP?
- Above the inguinal ligament vs. Below the inguinal ligament?
GIT Exam - Abdomen - Other? (3)
Rectal examination, vital signs, urinalysis
Rectal Examination Protocol?
Rectal Examination Protocol
Inspection = 9
Palpation = 10
