CLIN GIT Systems Review - Week 4

Question 1

GIT Systems Review Qs

Answer 1

• Abdominal pain
  o Do you ever suffer from stomach/abdominal/tummy pain? Acute or chronic? Onset? Frequency? Radiation ? Character ? Aggravating and reliving factors?
• Nausea
  o Do you ever feel nauseated?
• Vomiting
  o Do you ever vomit? Timing ? Contents ?
• Haematemesis
  o Do you ever vomit up blood?
• GORD/Heartburn
  o Do you ever feel like there is acid at the back of your chest, throat or neck? Is it worse on laying down or after eating particular foods? Waterbrush ? Does smoking, alcohol, chocolate, Ca2+ channel blockers, coffee make it worse?
• Post-prandial fullness /Early satiation
  o Do you feel fuller than normal after meals? Do you feel fuller sooner when eating?
• Dysphagia/Odynophagia
  o Do you ever have difficulty swallowing? Do you ever experience pain when swallowing?
• Bowel habits
  o Have you noticed any changes in your bowel habits? Diarrhoea – acute/chronic, confirm what is meant by the term ‘diarrhoea,’ character (appearance & smell), volume? Constipation – acute/chronic, confirm what is meant by the term ‘constipation,’ medications, past history, excessive straining, associated pain/discomfort?
• Blood in stools
  o Have you ever noticed blood in your stools? Is it fresh, mixed in or dark ?
• Mucous in stools
  o Have you noticed any mucous in your stools?
• Flatus
  o Are you passing wind?
• Bloating/distension
  o Have you noticed any bloating? Ankle oedema? Swelling ?
• Liver
  o Have you noticed any change in the colour of your skin, eyes, urine and/or bowel movements? Jaundice? Icterus ? Have you had an itch ? Any associated abdominal pain?
• Systemic symptoms
  o Have you had any fevers recently? Lethargy ? Appetite? Change of weight? Travel? Iron-deficiency anaemia?

Question 2

Abdo pain that radiates to the back may indicate

Answer 2

Pancreatic disease, peptic ulcer

Question 3

Abdo pain that radiates to the shoulder may indicate

Answer 3

Diaphragmatic irritation

Question 4

Abdo pain that radiates to the throat may indicate

Answer 4

Oesophageal reflux or spasm.

Question 5

Dull or burning abdo pain, often relieved by food or antacids may indicate

Answer 5

Peptic ulcer disease.

Question 6

Steady epigastric pain that is relieved by sitting up and leaning forward w radiation to the back may indicate

Answer 6

Pathology of the pancreas.

Question 7

Severe, unpredictable, constant pain which can last for hours may indicate

Answer 7

Biliary colic/Cholelithiasis. Shift to RUQ may indicate cholecystitis.

Question 8

Colicky pain (coming and going in waves) is related to ____ movements and may indicate

Answer 8

Bowel obstruction, ureter obstruction.

Question 9

Frequent waves suggest and less frequent waves

Answer 9

Small bowel obstruction (every 2-3 mins). Large bowel obstruction (every 10-15 mins).

Question 10

Vomiting may indicate

Answer 10

GIT infections, pregnancy, drug reactions, peptic ulcer disease, motor disorders, acute hepatobiliary disease, alcoholism, psychogenic vomiting, eating disorders, increased intracranial pressure, gastric outlet obstruction, gastroparesis.

Question 11

Vomiting >1hr post meal may indicate

Answer 11

Gastric outlet obstruction, gastroparesis.

Question 12

Early morning vomiting before eating may indicate

Answer 12

Pregnancy, alcoholism, raised intracranial pressure.

Question 13

Vomiting bile may indicate

Answer 13

Open connection btw duodenum & stomach.

Question 14

Vomiting old food may indicate

Answer 14

Gastric outlet obstruction.

Question 15

Vomiting white blood may indicate

Answer 15

Ulceration.

Question 16

Define waterbrush

Answer 16

Excessive secretion of saliva into the mouth.

Question 17

Waterbrush may indicate

Answer 17

Peptic ulcer disease or esophagitis.

Question 18

Post-prandial fullness may indicate

Answer 18

Functional dyspepsia.

Question 19

Early satiation may indicate

Answer 19

Gastric cancer, peptic ulcer/s

Question 20

3 causes of watery & high volume stools

Answer 20

Secretory diarrhoea - net secretion of the colon small bowel > absorption which persists when the pt fasts, w/out pus/blood, stools are not excessively fatty
Osmotic diarrhoea - large-volume stools related to the ingestion of food due to excessive solute drag which disappears when the pt fasts
Abnormal intestinal motility

Question 21

Secretory diarrhoea may indicate

Answer 21

Infections, hormonal conditions, villous adenoma.

Question 22

Osmotic diarrhoea may indicate

Answer 22

Lactose intolerance, magnesium antacids, gastric surgery.

Question 23

Abnormal intestinal motility may indicate

Answer 23

Thyrotoxicosis, irritable bowel syndrome.

Question 24

Stool containing blood or mucous may be caused by

Answer 24

Exudative diarrhoea - small-volume stools but frequent which may have blood/mucous

Question 25

Exudative diarrhoea may indicate

Answer 25

Inflammatory bowel disease, colon cancer.

Question 26

Fatty stools may indicate

Answer 26

Malabsorption - fatty, pale-coloured, smelly, float, difficult to flush

Question 27

Fatty stools may indicate

Answer 27

Severe pancreatic disease.

Question 28

Constipation may refer to

Answer 28

Both the infrequent passage of stools (<3/wk), hard stools or stools that are difficult to evacuate.

Question 29

Causes of constipation

Answer 29

Habitual neglect of the impulse to defecate, medications, hypothyroidism, hypercalcaemia, diabetes mellitus, phaechromocytoma, porphyria, hypokalaemia, aganglionosis, Hirschsprung’s disease, autonomic neuropathy, spinal cord injury, MS, partial colonic obstruction due to carcinoma, slow-transit constipation, late stages of pregnancy, irritable bowel syndrome.

Question 30

Mucous in stools may indicate

Answer 30

Solitary rectal ulcer, fistula, villous adenoma, irritable bowel syndrome.

Question 31

Abdominal distension/swelling may indicate

Answer 31

Ascitic fluid accumulation.

Question 32

What is pruritis?

Answer 32

Itching.

Question 33

Pruritis may indicate

Answer 33

Cholestatic liver disease.

Question 34

Fatigue (in GIT cases) may indicate

Answer 34

Acute or chronic liver disease, anaemia due to gastrointestinal or chronic inflammatory disease.

Question 35

PMHx hepatits may predispose to

Answer 35

Cirrhosis, liver failure, cancer.

Question 36

PMHx gallstones may predispose to

Answer 36

Potential complications

Question 37

PMHx diabetes may predispose to

Answer 37

Fatty liver disease

Question 38

FHx gastrointestinal disease may predispose to

Answer 38

IBD, coelic disease, gallstones, colon cancer

Question 39

MHx of prolonged NSAID use may predispose to

Answer 39

Peptic ulcer disease

Question 40

MHX statins may predipose to

Answer 40

Liver disease

Question 41

MHx recreational drug use may predipose to

Answer 41

Blood-borne viruses.

Question 42

MHx anabolic steroids, contraceptive pill may predispose to

Answer 42

Dose-related cholectasis, peliosis.

Question 43

MHx alcohol, tetracycline, valproic acid, amiodarone may predispose to

Answer 43

Fatty liver.

Question 44

MHx acetominophen overdose may predispose to

Answer 44

Acute liver cell necrosis.

Question 45

PMHx of general anaesthetic may predispose to

Answer 45

Jaundice, hypoxaemia of liver cells, direct damage to the bile duct during abdominal surgery

Question 46

PMHx of relapsing & remitting epigastric pain for pt presenting w severe epigastric pain may predispose to

Answer 46

Peptic ulcer perforation.

Question 47

RUQ pain and fever may indicate

Answer 47

Acute cholecystitis.

Question 48

Jaundice, pain in the RUQ & fever may indicate

Answer 48

Acute cholangitis.

Question 49

RUQ pain & jaundice may indicate

Answer 49

Choledocholithiasis.

Question 50

Sudden attack of abdominal pain epigastric pain, w tachycardia and sweating may indicate

Answer 50

Large AAA or ruptured AAA.

Question 51

Haematemesis may be caused by

Answer 51

Peptic ulcer, ruptured oesophageal variocele, Mallory-Weiss tear.

Question 52

Name for fresh blood in stools =

Answer 52

Haemochezia.

Question 53

Name for dark blood in stools =

Answer 53

Melaena.