Gastro - symptoms + signs Flashcards
Boerhaave’s syndrome symptoms + signs
- Chest pain (retrosternal, epigastric)
- Pneumomediastinum
- Shock (dyspnoea, tachypnoea, low BP, narrow pulse pressure)
- Subcutaneous emphysema
- L sided pleural effusion
Presents with chest pain, pt likely in shock (hypotension)
Mackler’s triad – classical presentation
• Chest pain
• Vomiting
• SC emphysema (air trapped in SC tissues)
Hours to days later • Pleural effusions (L side) \+/- Pneumothorax Widened mediastinum SC emphysema Hamman's sign - crunching sound upon auscultation of the heart due to pneumomediastinum
Haemorrhoids symptoms
- Bleeding (most common symptom)
- Itching
- Anal lumps
- Prolapsing tissue
- Pain
- Tenesmus
Acute Appendicitis symptoms
- Abdominal pain + vomiting
Poorly localised at the start, then localises in the RIF - Diminished BS
- Rovsing’s sign - palpation of the LIF results in greater pain in the RIF than the L
- McBurney’s sign - Percussion tenderness maximal over a point approximately 2/3 of the distance from the umbilicus laterally towards the ASIS
- Obturator sign/Cope’s sign - pain when passively internally rotating the hip
- Psoas sign - pain when passively extending the hip (represents a retrocaecal appendix)
- Dunphy’s sign - aggravation of abdominal pain by coughing
- PR - R sided tenderness
- Signs of peritonitis if perforation is present
What do the different appendicitis signs mean?
- Rovsing’s sign - LIF palpation results in RIF pain
- McBurney’s/Aaron’s sign sign - percussion tenderness maximal at a point approx 2/3 away from umblilicus towards ASIS
- Obturator sign/Cope’s sign- pain when passively internally rotating the hip
- Psoas sign - pain when passively extending the hip sign of a retrocecal appendix
- Dunphy’s sign - aggravation of abdominal pain by coughing
Perforated appendix symptoms
- Fever
- Flushed
- Tachycardic
- Peritonitis
- Diminished BS
Bowel / intestnal obstruction clinical features
- Absolute constipation + paralytic ileus – no flatus
- Diffuse Colicky abdominal pain
- Distended abdomen, tympany due to air-filled stomach
- N+V (esp in small bowel obstruction)
- Change in bowel habits – Failure to pass bowel movements
- In low level obstruction there may be a hx of progressive constipation or change in bowel habit
- Severe pain + tenderness - ischaemia or perforation
- High-pitched bowel sounds - obstruction
- Silent bowel sounds - ileus or perforation
- Abdominal mass
- Dehydration
- Empty rectum on DRE – proximal obstruction
- Soft stools on DRE – partial obstruction
- Acute abdomen with peritonism, tachycardia, fever - ?perforation
L-sided vs R-sided colon cancer
L sided - presents earlier, less advanced disease on presentation
- Early change in bowel habits
- Colicky abdominal pain
- Bowel obstruction
- Rectal bleeding
- Tenesmus
- Mass in LIF
R sided - presents later, more advanced disease at presentation
- Anaemia
- Weight loss
- Occult bleeding (bleeding not visible to the patient or the physician but it can cause iron deficiency anaemia)
- Mass in RIF
Volvulus symptoms
- Severe colicky abdominal pain + distension
- Absolute constipation - intestinal obstruction
- Hx of transient attacks in which spontaneous reduction of the volvulus has occured - relieved by passage of large amount of stool +/or flatus
- Vomiting - occurs late when destruction might be severe, leads to metabolic acidosis
Colonic perforation symptoms + signs
- Peritonitis
- Fever
- Tachycardia
- Hypotension
- Signs of dehydration
- Oliguria
- Shock
Gallstones + biliary colic symptoms + signs
- Biliary colic Constant pain RUQ May radiate around to the back in the interscapular region Increases in intensity + lasts for hours - N + V
Cholecystitis symptoms + signs
- Main difference from biliary colic is the inflammatory component
Local peritonism
Fever
Raised WCC - Intense, constant RUQ pain radiating to back, R shoulder, chest
- Distended, tender, palpable gallbladder
- Murphy’s sign
- Boas Sign- pain radiates scapula
- N+V
Acute cholangitis signs + symptoms
Charcot’s triad
- RUQ pain
- Fever
- Jaundice
Reynold’s pentad also includes
- Hypotension
- Altered mental status
- Pruritus
- Pale stools - deficient bile secretion to the small intestine
- Leukocytosis
- Abnormal LFTs
Mallory Weiss tear signs + symptoms
- Haematemesis
- Dizziness
- Postural hypotension
- Melaena
- Rockall score <3
Toxic megacolon symptoms and signs
- Large bowel dilation >6cm
- Abdominal tenderness
- Abdominal distention
- Tachycardia
- Anaemia
- Fever
- Pt acutely unwell
NON-OBSTRUCTIVE dilation of the bowel
Systemic upset
Cirrhosis symptoms + signs
- Ascites
- Peripheral oedema
- Jaundice + pruritus
- Haematemesis + melaena
- Hand + nail features Leukonychia Palmar erythmea Spider naevi Bruising Clubbing Dupuytren's contracture
- Facial features Telangiectasia Scleral icterus Spider naevi Red tongue Xanthelasma
- Abdominal features
Caput medusae
Hepatosplenomegaly
Distension - Gynaecomastia
- Loss of secondary sexual hair/testicular atrophy in men
- Muscle wasting
- Easy bruising
- Signs of portal HTN
Ascites
Caput medusae
Enlarged spleen - Signs of hepatic encephalopathy
Complications of cirrhosis
Related to the development of liver insufficiency + portal HTN
• Anaemia, thrombocytopenia, coagulopathy
Anaemia – folate deficiency, haemolysis, hypersplenism
Thrombocytopenia – 2o to hypersplenism + low levels of thrombopoietin
Coagulopathy - decreased hepatic production of coagulation factors, cholestasis causes decreased vitamin K absorption, decreased hepatic production of factors 2, 7, 9, 10
• Oesophageal varices – upper GI endoscopy
o Portal HTN
o Prophylactic abx at presentation
o Endoscopic variceal band ligation for primary prevention of bleeding
• Ascites – abdo US
o TIPS for people with cirrhosis who have refractory ascites
o May be associated with spontaneous bacterial peritonitis SPB = ascites neutrophils > 250 cells/mm3
o Spread of bacteria across the gut wall/haematogenus bacterial spread
o E. coli
- Portal HTN (causes distortion of the hepatic vasculature + can lead to increased intrahepatic resistance)
- Liver failure
- Hepatocellular carcinoma – abdo US/CT/MRI
- Jaundice
- Portosystemic encephalopathy
- AKI
- Hepatopulmonary syndromes – pulmonary arteriolar vasodilation, shunting, hypoxaemia
- Cirrhotic cardiomyopathy – cardiac hypertrophy + blunted stress response of the heart
Wernicke’s encephalopathy triad
CAN
- Confusion
- Ataxia
- Nystagmus (Opthalmoplegia)
(due to vitamin B1 deficiency)
Grade 0 hepatic encephalopathy symptoms + signs
Normal mental status
Minimal changes in memory, concentration, intellectual function, co-ordination
Grade I hepatic encephalopathy symptoms + signs
- Change in behaviour
- Mild confusion
- Slurred speech
- Euphoria or depression
- Decreased attention
- Slowing ability to perform mental tasks
- Disordered sleep
Grade 2 hepatic encephalopathy symptoms + signs
- Obvious personalty changes
- Inappropriate behaviour
- Lethargy
- Moderate confusion
- Drowsiness
Grade 3 hepatic encephalopathy symptoms + signs
- Marked cofusion (stupor)
- Unable to perform mental tasks
- Disorientation to time and place
- Occasional fits with rage
- Incoherent speech
- Sleeping but arousable
Grade 4 hepatic encephalopathy symptoms + signs
- Coma- +/- response to pain
N+V+D approx 1-6h following ingestion of contaminated dairy products or cold meat
Organism and treatment?
Staph aureus
Produces heat-stable endotoxin
Supportive treatment
V+ later D following consumption of reheated rice
Organism?
Bacillus cereus
D typically occurs 8-16h following vomiting
