gastro exam Flashcards
what should be position?
lying flat
general inspection list 6
jaundice anaemia tattooes distension medical parephrenelia
why would you ask the patient to cough in an abdo exam?
coughing increases intraabdominal pressure which would cause an inguinal hernia to appear
what gastro causes results in anaemia?
GI bleed
malignancy
malnutrition / absorption
3 causes of jaundice?
acute hepatitis
liver cirrhosis
cholangitis
why would there be hyperpigmentation present in a patient with a gastro condition?
what does it make you think of?
haemochromatosis
oedema
how does it present
what does it relate to in an abdo exam/
ascites
liver failure
medical paraphrenelia?
stoma bags
surgical drains
feeding tubes
signs on the palms?
palmar erythema
dupuytrens contracture
what is koilonychia and when does it present ?
spoon-shaped nails, associated with iron deficiency anaemia (e.g. malabsorption in Crohn’s disease).
what is leukonychia
why does _____ cause it?
whitened nail bed
assoiciated with hypoalbuminaemia
end stage liver disease
protein losing enteropathy
hypoalbuminaemia would cause edematous state in the nail bed which could mean pressure applied by excessive fluid hides the normal red state
abdo causes of clubbing?
IBD
coeliac disease
liver cirrhosis
lymphoma
why do you assess astrexis in an abdo exam?
co2 retention when type 2 resp failure
but abdo causes - known as the hepatic flap
suggests hepatic encephalopathy - dysregulation of the diencephalic motor centers in the brain that regulate innervation of muscles responsible for maintaining position hence the flap - due to hyperammoniaemia
uraemia 2ndary to renal failure
dupuytrens contracture
what is it ?
why does it occur
how to assess
what does it feel like?
thickening of the palmar fascia
contracture deformities pulling thumb / fingers
most commonly fourth or fifth fingers
feels like thickened palmar fascia
diabetes
alcohol abuse
hiv infection
why do you need to inspect axilla for abdo?
what shows insulin resistance or GI malignancy?
acanthosis nigricans
darkening / thickening of armpits
hair loss of axilla is associated with iron deficiency anaemia and malnutrition
what signs can be present on the arms?
bruising
excoriations
needle track marks
bruising-
suggests clotting factors may be deranged - hepatic problem
excoriations
scratch marks - pruritus suggests cholestasis and high bilirubin in blood causes itching
track marks
iv drug use - hepatitis b/c
IBD ? CROHNS
what signs on examination suggest IBD
eye: inflammation of area next to iris - anterior uveitis - crohns
mouth signs anaemia / iron deficiency
angular stomatitis
glossitis
Aphthous ulceration
b12 / folate deficiency mouth signs
what is glossitis ?
glossitis is smooth enlargement of really red tongue
what are all the mouth signs you should look out for?
angular stomatis
glossitis
oral candidiasis - immunosuppression/ fungal infection
aphthous ulceration
hyperpigmented macules - pathogonomic for peutz- jeghers syndrome polyps in GI tract
virchows node
what is it?
what is it significance?
left supraclavicular lymph node recieves it’s lymphatic drainage from the abdominal cavity
so its enlargement in an abdo context is alarming for malignancy - metastatic
spider naevia - what is this?
why does it occur
what hormone is increased in circulation?
how many is significant?
skin lesions that have a central red papule with fine red lines
caused by increased oestrogen
> 5 abnormal
suggestive of liver cirrhosis
signs on chest?
spider naevi
gynaecomastia
hair loss
all occur due to inc oestrogen circulating
and they all suggest liver cirrhosis
why is increased circ oestrogen suggestive of cirrhosis
liver is responsible for metabolizsing and inactivating estrogen so increased oestrogen signs suggest liver dysfunction reliably
6 f’s of abdo distension?
fulminant mass fetus faeces flatus fat fluid
what is bruising around the umbilicus called?
cullens
bruising in flanks?
grey turners
haemorrhagic pancreatitis
caput medusae
engorged paraumbilical veins
associated with portal hypertension
if a mass is found what should you assess about it?
5
location size/ shape consistency mobility pulsatility
why do you ask to breath in when palpating?
diaphragm moves up liver moves down
how do you assess the liver edge?
how much extension is significant?
what kind of consistency suggests cirrhosis
what is pulsatile hepatomegaly associated with?
Degree of extension below the costal margin: if greater than 2 cm this suggests hepatomegaly.
consistency of the liver edge - nodular cirrhosis
tricuspid regurgitation
murphys sign positive?
cholecystitis
deep inspiration palpate mcl right costal margin
for splenomeglay to be noted how much bigger would the spleen need to be?
causes of splenomegaly?
3x hemolytic anaemia - sickle cell portal hypertension 2 liver cirrhosis glandular fever heart failure
do you ballot the kidneys on inspiration or expiration and why?
what are causes of an enlarged kidney?
on inspiration
polycystic kidney disease
amyloidosis
ascities
percuss from middle to patients left
ask patient to turn towards you
wait 30 seconds
repeat
resonant > dull then once turned towards you the dull area would not be resonant
what does pitting oedema of the legs suggest?
hypoalbuminaemia - liver cirrhosis / protein losing enteropathy
bruits - abdo
aortic- 1-2cm superior to umbilicus
renal bruits - 1-2 cm superior and slightly lateral to midline on either side
renal artery stenosis
PT presents with impulsiveness and psychiatric symptoms but is referred for a gastro review
examination: ataxia on entering room, rigidity of muscles in neuro limb exam
hands had a tremor, scleral icterus, kayser fleischer rings in the eyes were observed
Coombs negative haemolytic anaemia
mild hepatomegaly
what condition ?
what is its etiology of disease?
Ix?
Mx?
wilsons disease- autosomal recessive
excess copper stored in tissues which when liberated can cause the kayser fleischer rings and non immune haemolytic anaemia
24 hr urinary collection is ix of choice
atp7b gene diagnosis confirms
Mx
chelators : D-penicillamine +zinc salts
female pt presents with lethargy, erectile dysfunction and polyuria, polydipsia and nocturia - she thinks it may be as a result of her menopause and periods ending
on examination pt seems very tanned despite no holiday
jaundice, ascites and stigmata of disease on the cuticles
on palpation ; hepatomegaly , cardiac failure signs
what is wrong with the pt?
Ix?
Mx?
Haemochromatosis
Ferritin, transferrin saturation , TIBC- the binding capacity is low as there is so much iron going
Venesection
how does Deferoxamine work
what does it treat
is it first line or second line?
binds to iron and allows it to be excreted
haemochromatosis
second line
If mx includes IV fluids what do you say?
I would ensure it is documentated how much fluid input /output is happening
ensure reassessment clinically and biochemicallly
