gastro

Question 1

general appearance

Answer 1

confusion
pain
jaundice
hyperpigmentation
oedema
cachexia
hernias

VSS

Question 2

hands

Answer 2

leukonychia-whitening of nail bed ?hypalbuminaemia
koilonychia-spooning ? iron deficit
palmer erythema- ? chronic liver disease
dupuytren’s contractors-thickening ring finger palm ligament- ? alcohol use or genetics/manual labour
asterix-hepatic flap- ? hepatic encephalopathy or uraemia due to renal failure
clubbing-check schamroths sign- ? IBD liver cirrhosis, lymphoma of GIT, hypoalbuminemia

Question 3

arms

Answer 3

brusing-?abnormal clotting due to liver disease
excoriations- scratch marks from pruritis ? infective cholestasis
track marks- ? high risk of viral hepatitis
hair loss-?decrease iron and malnutrition
acanthosis nigricans(hyperpigmentation)-insulin resistant or GI malignancy

Question 4

eyes

Answer 4

conjuntive pallor ? anaemia
jaundice ? liver disease
Xanthelasma ? high cholesterol

Question 5

mouth

Answer 5

angular stomatitis ? low iron, GI malignancy, malabsorption
oral candidiasis ? fungal infection due to immunosuppressed
central cyanosis
dentition
apthous ulceration ? stress, trauma, low iron B12 folate, crohn’s

Question 6

neck

Answer 6

swollen lymph nodes

submental
submandibular
preauricular
postauricular
tonsillar
posterior cervical
anterior cervical
occipital

supraclavicular-virchow’s node ? metastatic intrabdominal malignancy

JVP under 4cm and hepatic jugular reflex ? fluid overload

Question 7

chest

Answer 7

spider naevi ? increase oestrogen due to cirrhosis if more then 5 seen (or pregnant or “pill”)
gynaecomastia (man boobs) due to cirrhosis or medication
hair loss ? cirrhosis or malnutrition
excoriation due to pruritis ? infective cholestasis

Question 8

abdo

Answer 8

inspect

• scars ? surgery
• hernias
• masses
• striae
• medusae

palpate

• 4 quadrants soft then hard
• inferior liver
• spleen
• ballot kidney

percuss

• liver inferior (and superior if concern)
• spleen
• shifting dullness

Auscultate 4 quadrants for 5min for bowel sounds

Question 9

legs

Answer 9

pain-calf pain
oedema
hair loss
pigmentation

pulses dorsalis pedis, posterior tibiotarsi

Question 10

special tests and summary

Answer 10

murphy sign
rosving sign
mcburneys point
renal angle tenderness

thank patient- recommend u/a and hcg if woman (pending assessment)