Gastrointestinal

Question 1

Clubbing

Answer 1

Liver cirrhosis + IBD

Question 2

Leukonychia

Answer 2

Liver cirrhosis

Question 3

Koilonychia

Answer 3

Iron-deficiency anaemia

Question 4

Dupuytren’s contracture

Answer 4

Alcoholic liver disease

Question 5

Palmar erythema

Answer 5

Excess oestrogens - pregnancy, hyperthyroidism, chronic liver disease

Question 6

Asterixis (liver flap)

Answer 6

Accumulation of ammonia

Question 7

Jaundice

Answer 7

Liver cirrhosis

Pancreatic cancer (compresses bile duct)

Question 8

Angular stomatitis

Answer 8

Iron, B2, B6 deficiency

Question 9

Perioral pigmentation

Answer 9

Hereditary haemorrhagic telangiectasia (HHT)

Question 10

Mouth ulcers

Answer 10

Crohn’s

Question 11

Hepatic foetor

Answer 11

Liver disease

Question 12

Glossitis

Answer 12

Iron and B vitamin deficiency

Question 13

Gynaecomastia

Answer 13

Chronic liver disease

Question 14

Spider naevi

Answer 14

High oestrogen - chronic liver disease

Question 15

How many spider naevi is considered abnormal?

Answer 15

More than 5

Question 16

Splenomegaly

Answer 16

Portal hypertension caused by chronic liver disease

Question 17

Absent bowel sounds

Answer 17

Peritonitis

Question 18

High-pitched ‘tinkling’ bowel sounds

Answer 18

Bowel obstruction

Question 19

Bruit

Answer 19

Atherosclerosis

Question 20

Oedema

Answer 20

Liver failure

Question 21

Why is an external genitalia examination performed?

Answer 21

To exclude possible testicular torsion as a cause for abdominal pain.

Also, to examine for testicular atrophy, a feature of chronic liver disease