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Clinical Examinations > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

0
Q

Summarise what you are looking for on general inspection?

A 
Abdominal swelling
Obvious signs of smoking
A drip
Tube feeding (NG or IV)
Cartons of food lying around
Any medicines
How patient generally looks - large/small body habitus?
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1
Q

How must patient be positioned for gastro exam?

A

Patient must be lying flat

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2
Q

Five Fs of abdominal swelling?

A 
Fat
Flatus
Fluid
Faeces
Foetus
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3
Q

Summarise what looking for on inspection of hands?

A 
Tattoos
Clubbing
Koilonychia 
Leuxonychia
Beau's lines
Terry's nails
Dupyten's contracture
Spider naevi 
Bruising
Oedema
Jaundice
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4
Q

GI causes of clubbing?

A

UC, Crohn’s, coeliac disease

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5
Q

What is koilonychia? What causes it?

A

Spoon shaped nails - sign of iron deficiency anaemia

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6
Q

What is leuconychia? What causes it?

A

White nails.

Sign of hypoalbuminaemia, and hence liver failure

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7
Q

What are Beau’s lines? What causes it?

A

White lines across nails (not raised). Sign of acute illness.

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8
Q

What are Terry’s nails? What is it a sign of?

A

‘Ground glass’ appearance. Can be a sign of liver or renal failure.

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9
Q

What is Dupytens contracture? What is it associated with?

A

When finger is vent towards palm of hands, palmar aponeurosis may be hard and tight.
Associated with alcoholic liver disease.

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10
Q

What are spider naevi? What is it associated with?

A

Little vascular raised things on the skin that blanch on pressure. Found anywhere drained by SVC - face, forearms, trunk.
Associated with any condition that causes increased circulating oestrogen eg cirrhosis or pregnancy.

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11
Q

What might bruising be associated with?

A

Chronic liver disease

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12
Q

What are the liver dependent clotting factors?

A

2, 7, 9 and 10

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13
Q

Summarise what looking for in the mouth?

A 
Lips - angular stomatitis 
Gums - damage/inflammation/hypertrophy 
Teeth
Candida
Glossitis
Ulceration
Leukoplachia 
Anaphylaxis
Cheeks
Pigmentation around lips
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14
Q

What is angular stomatitis a sign of?

A

Iron deficiency anaemia or dehydration

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15
Q

When may gums be hypertrophied?

A

When being treated with cyclosporin or some epilepsy drugs

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16
Q

Teeth may lose enamel due to what?

A

Chronic gastric reflux/vomiting

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17
Q

Difference between candida and normal tongue covering?

A

Candida can’t be scraped off

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18
Q

Glossitis is a sign of what?

A

Iron deficiency anaemia

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19
Q

How does glossitis appear?

A

Smooth shiny and red

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20
Q

Ulceration may arise from what?

A

Ill-fitting dentures

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21
Q

What is leukoplachia?

A

White, hairy plaque on tongue

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22
Q

What is leukoplachia a sign of?

A

Pre-malignancy

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23
Q

What is anaphylaxis?

A

Rapid swelling of tongue due to hypersensitivity reaction

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24
Q

What is pigmentation around the lips a sign of?

A

Peutz-jegher’s syndrome. (Leads to polyp formation in digestive tract - high cancer risk)

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25
Q

How do you check for jaundice in the eyes?

A

Ask patient to look at floor and lift up their top eyelids.

26
Q

How do you check for anaemia in the eyes?

A

Ask patient to look to ceiling and pull down their bottom eyelids and look in the conjunctiva

27
Q

What are Kayser Fiesher rings?

A

Rings that encircle the iris - result of copper deposition often caused by Wilson’s disease.

28
Q

Summarise what looking for in eyes?

A

Jaundice
Anaemia
Kayser Fiesher rings
Hyperlipidaemia - xanthelasma, corneal arcus

29
Q

What is xanthelasma and what causes it?

A

Lipid deposits around the eyes - can be a sign of diabetes or high cholesterol.

31
Q

What is corneal arcus and what is it a result of?

A

Lipid deposits in conea - develop naturally in old age, can be pathological if younger

32
Q

Summarise what looking for in neck/chest?

A

Lymph nodes
Spider naevia
Looking for symmetry of chest and abdomen as it rises and falls

33
Q

What should you do before you palpate the abdomen?

A

Ask the patient if they have any tenderness, and if they do, leave this area until last

34
Q

What do the two types of palpation look for?

A

Masses and tenderness

35
Q

What should you be doing whilst you are palpating?

A

Looking at the patient’s face for non-verbal signs of pain

36
Q

Where do you start palpation of the liver?

A

Right iliac fossa

37
Q

What part of the hand do you palpate the liver with?

A

Outside edge of index finger

38
Q

When will you feel the liver?

A

When patient breathes in

39
Q

What are the two key features of the liver?

A

Cannot feel above it

Descends on inspiration

40
Q

What is the technique for palpating the spleen?

A

Same as liver but start in roughly same place but go diagonally towards the left

41
Q

What can you do if you can’t feel the spleen?

A

Ask patient to lie on their side and face you, and try again

42
Q

Can spleen/gallbladder usually be palpated?

A

No, not unless there is a pathological cause

43
Q

How do you feel for the kidney?

A

Ballot it

44
Q

Where do you palpate the aorta?

A

On either side of the midline on the patient’s front.

45
Q

What does it mean if aorta is pulsatile?

A

Normal

46
Q

The aorta should have a diameter of no larger than what?

A

4.5cm

47
Q

What will you feel if the aorta is expansile?

A

Hands will move up and out

48
Q

What are the two things you percuss for in the abdomen?

A

Fluid and liver

49
Q

How do you percuss for fluid in the abdomen?

A

Shifting dullness - begin percussing in middle of abdomen and gradually move to the patient’s side. If it is dull at the side, ask patient to roll over and leave them for 30 seconds. KEEP HAND IN SAME PLACE. If dull area has become resonant then the patient has shifting dulness.

50
Q

How should the fingers be oriented when percussing for shifting dullness?

A

Should be in line with patient’s trunk (i.e. in line with any possible fluid level) so that you can easily detect the fluid level.

51
Q

Where do you listen for bowel sounds?

A

About 2 inches above the umbilicus in the midline

52
Q

How will bowel sounds be if there is obstruction?

A

Tinkling

53
Q

What is absence of bowel sounds indicative of?

A

Peritonitis

54
Q

How long should you listen for if you don’t hear bowel sounds?

A

2-3 minutes

55
Q

What is a bruit?

A

Noises from turbulent blood flow through abnormally rough arteries.

56
Q

Common types of bruit

A

Renal and hepatic

57
Q

End pieces for gastro examination?

A 
Check external genitalia
Perform a rectal exam
Check for ankle oedema
Do a urine dipstick test
Check hernial orifices
58
Q

What is Grey-Turner’s sign and what can cause it?

A

Discolouration in the flanks as a result of blood leaking into subcutaneous tissues.
Can be causes by haemorrhagic pancreatitis, ruptured aortic aneurysm, ruptured ectopic pregnancy…

59
Q

What is Cullen’s sign and what can cause it?

A

Similar to Grey-Turner’s sign but around umbilicus. Same causes as Grey-Turner’s sign.

60
Q

What is Murphy’s sign and what can cause it?

A

Pain elicited when palpating in the region of the gallbladder. Worse on inspiration. Usually caused by inflammation of the gallbladder.

61
Q

What is rebound tenderness and what can cause it?

A

Press hard on abdomen then quickly release - if pain worse on releasing pressure then rebound tenderness is present.
Can be used to test for peritonitis.

62
Q

What is Rovsing’s sign and what can cause it?

A

When pressing in left iliac fossa pain may be felt on right iliac fossa. Reverse Rovsing’s may also occur.
Test for peritonitis.

63
Q

What is Psoas sign and what can cause it?

A

With patient lying down, place hand just above patient’s right knee then ask them to flex the right hip joint. If this causes severe pain then this is a positive psoas sign.

Test for appendicitis.

64
Q

What is obturator sign and what can cause it?

A

With patient lying down, and their right knee flexed, raise and internally rotate the leg. See if painful.

Test for appendicitis.

Clinical Examinations (10 decks)

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