Gastrointestinal Buzzwords

Question 1

Abdominal pain: Colicky loin pain radiating to groin

Answer 1

Ureteric colic

Question 2

Abdominal pain: Jaundice and intermittent right upper quadrant pain

Answer 2

Biliary colic

Question 3

Abdominal pain: Severe epigastric pain radiating to back associated with vomiting

Answer 3

Acute pancreatitis

Question 4

Abdominal pain: Peri-umbilical pain initially, then shift to right iliac fossa

Answer 4

Acute appendicitis

Question 5

Abdominal pain: Central abdominal pain, expansile pulsatile mass

Answer 5

Abdominal aortic aneurysm

Question 6

Abdominal pain: Iliac fossa pain, positive pregnancy test

Answer 6

Ectopic pregnancy

Question 7

GI Examination sign: Asterixis (liver flap)

Answer 7

Hepatic encephalopathy

Question 8

GI Examination sign: Leukonychia

Answer 8

Hypoalbuminaemia

Question 9

GI Examination sign: Glossitis (beefy tongue)

Answer 9

Vitamin B12 deficiency (or sometimes foliate deficiency)

Question 10

GI Examination sign: Aphthous ulceration

Answer 10

Inflammatory bowel disease, Coeliac disease

Question 11

ascites, pleural effusion and benign ovarian tumour

Answer 11

Meigs’ syndrome

Question 12

Lymphadenopathy, left supraclavicular fossa

Answer 12

Gastric adenocarcinoma (Virchow’s node), predominantly found on antrum along lesser curvature

Question 13

GI Examination sign: Angular stomatitis

Answer 13

Iron-deficiency anaemia

Question 14

Middle-aged woman presents with: Pruritus, jaundice, pigmentation. Anti-mitochondrial antibody (AMA) positive. Associated with: rheumatoid arthritis, Sjögren’s syndrome, Hypothyroidism or autoimmune disease

Answer 14

Primary biliary cirrhosis

Question 15

Usually middle-aged man, presents with: Pruritus, jaundice, abdominal pain ↑ ALP (alkaline phosphatase), AMA negative. Associated with inflammatory bowel disease (especially ulcerative colitis)

Answer 15

Primary sclerosing cholangitis

Question 16

4 Fs that predisposes primary biliary cirrhosis

Answer 16

Female, Forty, Familial, Fertile

Question 17

Reynold’s Pentad + very high bilirubin, Alk Phos, GGT

Answer 17

RUQ pain, Jaundice, Fever, Hypotension, Encephalopathy
Likely Ascending cholangitis
Cholangitis vs cholecystitis (4 F’s predispose to cholangitis, septic features point towards cholangitis)

Question 18

Pyoderma gangrenosum, erythema nodosum

Answer 18

UC/Crohn’s

Question 19

High pitched Tinkling bowel sounds

Answer 19

Bowel Obstruction

Question 20

“Rice-water”-like stools

Answer 20

Vibro Cholera

Question 21

Presence of AMA (Anti mitochondrial antibodies)

Answer 21

Primary Biliary Cirrhosis

Question 22

Presence of ASMA (anti smooth muscle antibodies) + ANF (Anti nuclear factor)

Answer 22

Autoimmune hepatitis

Question 23

Alpha Feto Protein assay or Serum AFP elevation

Answer 23

Primary hepatocellular carcinoma

Question 24

Causes of bowel obstruction

Answer 24

Bolus (Faecal Impaction common)
Adhesions
Tumour
Hernia
Volvulus
Intsuussception
Pseudo-obstruction
Stricture

Question 25

Crohn's acronym CAMMPERS

Answer 25

``` C: Cobblestone (on barium swallow) & clubbing A: Apthous ulcers M: Mass in right iliac fossa M: Malabsorption P: Peri-anal disease E: Erythema nodosum R: Rectal sparing S: Skip leisions/strictures ```

Question 26

Ulcerative colitis characteristics

Answer 26

Superficial inflammation, limited to mucosa Continuous Start from rectum and moves proximal Crypt abscess Associated with primary schlerosing cholangitis Smoking has a protective effect Toxic megacolon

Question 27

Crohn's characteristics

Answer 27

``` Knife-like, transdermal fissures Skip leisions Terminal ileum most common, can affect mouth to anus Non-caeseating granulomas Worsen by smoking Malabsorption Stricture formation and obstruction Peri-anal disease Anterior Uveitis ```

Question 28

Corrugated, 'feline' oesophagus + history of atopy

Answer 28

Eosinophillic oesophagitis (-ve for reflux)

Question 29

Bird's beak appearance

Answer 29

Achalasia of lower oesophageal sphincter

Question 30

Kayser Fleischer ring (greenish-brownish ring around pupil) + non-specific symptoms of cognitive decline

Answer 30

Wilson's disease Non-specific motor degeneration is due to accumulation of copper in brain and motor regions. Can be dyskinesia, tremour, dementia, dysarthalgia (speech impairment)

Question 31

Weight loss + Fatty stool + itchy blisters on elbow and knee

Answer 31

``` Coeliac disease most likely Dermatitis herpetiformis (itchy rash commonly on elbow, knee, shoulder, buttock, face) is a skin manifestation of coeliac disease ```

Question 32

Lanugo Hair

Answer 32

Associated with malabsorption in adults, Anorexia nervosa and/or bulimia nervosa usually underlying cause

Question 33

Dilated tapering oesophagus

Answer 33

Achalasia of lower oesophageal sphincter | Tapering: diminish in thickness/size towards the end. Same meaning as bird's beak appearance

Question 34

sensation of 'lump at back of throat'

Answer 34

Globus hystericus - usually caused by criccopharyngeal spasm (no obvious pharynx and oesophagus pathology), Zenker's diverticulum (accompanying dysphagia & halitosis), inflammation of larynx/hypopharynx, GORD

Question 35

Cockscrew Oesophagus (on barium swallow)

Answer 35

Diffuse Oesophageal Spasm

Question 36

1 year old baby with excessive inconsolable crying + sausage-shaped abdominal mass

Answer 36

Intussussception (most common in babies 2 months to 2 years, +/- rectal bleeding with red jelly-like appearance)

Question 37

Duodenal ulcer vs Peptic ulcer key difference

Answer 37

Duodenal ulcer relieved by eating or drinking milk, peptic ulcer worsened by eating

Question 38

Absent psoas shadow and sentinel loop of jejunum on AXR

Answer 38

Acute pancreatitis

Question 39

Signet Ring

Answer 39

Adenocarinoma (Signet Ring cells are a special type of mucin-secreting carcinoma, most common associated with stomach cancer, but also found in colon, breast, gallbladder and gonads)

Question 40

Gastric biopsy show heavy infiltrate of atypical lymphocytes + increased intra-epithelial lymphocytes

Answer 40

Most likely MALT-associated Lymphomas (if lymphocyte infiltrations is typical, then gastritis would be the diagnoses)

Question 41

Parasitic infection mostly in duodenum and jejunum

Answer 41

Giardiasis

Question 42

Special scan that determines lesion at ileocaecal valve

Answer 42

Meckel's Diverticulum (Ectopic Gastric mucosa is present at the site, usually near ileocaecal valve, Technetium-99 scan will indicate presence of gastric mucosa at ileocaecal valve. Meckel's diverticulum is usually asymptomatic)