Clinical Skills Flashcards
What is koilonychia a sign of?
iron deficiency, haemochromatosis, infection, endocrine disorders, malnutrition
what is koilonychia?
spoon shaped nails
What is clubbing a sign of in respect of GI?
cirrhosis, IBD, GI lymphoma, Malabsorption
Palmar erythema is a sign of what in GI?
liver cirrhosis
significant past MH in GI history?
peptic ulcers, carcinoma, jaundice, hepatits, blood transfusions, tattoos, previous operations, last menstrual period, dietary changes
significant drug history in GI history?
NSAIDs, steroids, antibiotics
significant FH in the GI history?
IBS, IBD, peptic ulcer disease, polyps, cancer, jaundice
Questions to ask regarding nausea/vomiting?
timing, content, relation to meals, amount
Questions to ask regarding haematemesis?
frequency, fresh (red or dark), neoplasia (weight, dysphagia, pain), NSAIDs, warfarin, surgery, smoking
Questions to ask regarding dysphagia?
level, onset, intermittent, progressive, painful swallow
Questions regarding changes in bowel habit?
timing, consider neoplasia (weight loss, dysphagia, pain, melaena)
Questions regarding rectal bleeding?
pain, mucus, fresh dark/black, mixed with stool, on surface, on paper, in the pan?
Questions regarding jaundice?
pruritis, dark urine, pale stools
Questions regarding weight change and appetite?
deliberate, quantify, dysphagia, pain
What is melaena?
black, tarry faeces
what is pruritis?
itch
Common causes of GI vomiting (7)
gastroenteritis, peptic ulceration, pyloric stenosis, intestinal obstruction, paralytic ileus, acute cholecystits, acute pancreatitis
Pain in the epigastric region may indicate?
pancreatitis, gastritis, duodenitis, peptic ulcer, gallbladder disease, aortic aneurysm
Pain in the LUQ may indicate?
Peptic ulcer, gastric or colonic cancer, splenic rupture, subphrenic or perinephric abscess, renal colic or pyelonephritis
Pain in the RUQ may indicate?
cholecystitis, biliary colic, hepatitis, peptic ulcer, colonic cancer, renal colic or pyelonephritis, subphrenic, perinephric abscess
Pain in the loin may indiacte?
renal colic, pyelonephritis, renal tumour, perinephric abscess
Pain in the LIF may indicate?
diverticulitis, volvulus, colon cancer, pelvic abscess, IBD, hip pathology, renal colic, UTI, cancer in undescended testis, zoster, torsion of ovarian cyst, ectopic pregnancy
Pain in the RIF may indicate?
Appendicitis, Chrons ileitis, diverticulitis, volvulus, colon cancer, pelvic abscess, IBD, hip pathology, renal colic, UTI, cancer in undescended testis, zoster, torsion of ovarian cyst, ectopic pregnancy
Pain in the Pelvic region may indicate?
UTI, retention, stones, menstruation, pregnancy, endometriosis endometritis, ovarian cyst torsion
Generalised Pain in GI may indicate?
Gastroenteritis, IBS, peritonitis, constipation
Central Pain in GI may indicate?
mesenteric ischaemia, abdominal aneurysm, pancreatitis
MI referred pain may go to…
the epigastric region or pleura
The five Fs of abdominal distension
Fat, Fluid, Faeces, Flatus, Fetus
Flatus will be ____ to percussion
resonant
Fluid will be _____ to percussion
dull
Steatorrhoea is…
pale stools that are difficult to flush due to high fat content
Causes of steatorrhoea are…
ileal disease, pancreatic disease, obstructive jaundice,
Tenesmus is…
a feeling of incomplete emptying after defacation
Causes of tenesmus are…
IBS but can be caused by tumours
Halitosis is…
oral malodour
Halitosis is the result of…
gingivitis, metabolic activity of bacteria in plaque
Contributing factors of halitosis?
smoking, drugs, lung disease, hangovers
General inspection of GI patient involves looking for?
vomit, stoma, jaundic, pale, BMI, scars on abdomen
On the hands look for (8)
clubbing, koilonychia, leuconychia, meuhrckes lines, palmar erythema, dupuytrens contracture, pigmentation of palmar creases, asterixis
Where will spider naevi be found?
arms, upper chest, upper back
On the neck inspect and feel for?
lymph nodes, JVP, tricuspid regurgitation, tunnelled haemodialysis lines
Why might JVP be raised in GI patient?
fluid overload, due to renal or liver dysfunction
Why is tricuspid regurgitation relevant in GI patients?
can cause pulsatile hepatomegaly
What signs are looked for in the eyes of GI patients?
jaundice, conjunctival pallor, Kayser-Fleischer rings, xanthelasma, sunken eyes
What signs are looked for in the mouth of GI patients?
angular stomatisis, pigmentation, telangiectasia, ulcers, glossitis
What are Kayser-Fleischer rings?
dark rings that encircle the iris, copper deposition due to liver diseases
What might sunken eyes in a patient indicate?
dehydration
What is angular stomatisis?
inflammation of the corners of the mouth
What is telangiectasia?
spider veins
what is glossitis?
soreness and redness of the tongue, can indicate depappilation
before palpating the abdomen what should be asked?
if there is any tender areas
You avoid palpating tender areas first, why?
patient will tense and thus cause difficulty in palpating the rest of the abdomen
Which organs should you be able to percuss (GI)?
liver, spleen, bladder if enlarged
What should be auscultated in GI patients?
bowel sounds, aortic and renal bruits
what is leuconychia?
whitening of the nails due to hypoalbuminaemia
What are Muehrchkes lines?
transverse white lines due to hypoalbuminaemia
what are blue lanulae?
blueish discolouration of hands due to Wilsons disease
What is dupuytrens contracture?
thickening and fibrous contraction of palmar fascia
What causes dupuytrens contracture?
alcoholic liver disease
What causes hepatic flap?
hepatic encephalopathy, uraemia from renal disease
causes of hepatomegaly
malignancy, hepatic congestion, RHF, glandular fever, hepatitis, malaria, schistomiasis, amoebic disease, leukaemia, lymphoma, sickle cell, haemolytic disease, fatty liver, amylodosis
