Gastrointestinal Examination Flashcards by Olivia Mooney

What are some of the core presenting symptoms

Abdominal pain
Distension
Nausea and Vomiting
Haematemesis
Dysphagia
Indigestion/dyspepsia/reflux
Recent change in bowel habit
Diarrhoea
Constipation
Rectal bleeding or melaena
Appetite change
Weight loss
Jaundice

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In terms of PMH what is it important to ask about in the GI system?

peptic ulcer disease
carcinoma
jaundice
hepatitis
blood tranfusions
tattoos
previous operations
last menstrual period
dietary changes

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What are the 5 causes of distension?

Fat, Fluid, Faeces, Flatus, Fetus

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What are the main GI causes of vomiting?

gastroenteritis
peptic ulcer
pyloric stenosis
intestinal obstruction
paralytic ileus
acute pancreatitis/cholecystitis

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What are the main CNS causes of vomiting?

meningitis/encephalitis
migraine
increased ICP
brainstem lesion
motion sickness
Menieres disease

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What are the main endocrine/metabolic causes of vomiting?

uraemia
hypercalcaemia
hyponatraemia
DKA
pregnancy
Addison’s

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What is the general sequence of the abdominal examination?

General inspection
Hands - inspection, asterixis
Arms - pulse, BP, SVC, tack marks
Neck - lymph nodes, JVP, scars
Face - skin + eyes, mouth
Abdomen
- Inspection
- Palpation
- Percussion
- Ausculation
To complete - ankle oedema, hernias, external genitalia, DRE, urine dipstick

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What are the main causes of a transudate ascites

Low protein

Chronic Liver disease
RHF
VOlume overload
hypoalbuminaemia
constrictive perciarditis

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What are the main causes of an exudate ascites?

high protein

Infection
Inflammation
Malignancy

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What can be inspected from the end of the bed in a GI examination?

general appearance (well/unwell)
Oxygen, drips, catheters, medications
Nutritional status, cachexia

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What are the main features that can be observed in the hands in a GI examination?

Tendon xanthomata
Dupuytren’s contracture
Palar erythema

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What is tendon xanthomata a sign of?

hyperlipidaemia (PBC, cholestasis)

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What is dupuytren’s contracture a sign of?

Chronic liver disease
diabetes mellitus
heavy labour
phenytoin
trauma
familial

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What is palmar erythema a sign of?

Chronic liver disease
pregnancy
hyperthyroidism
RA

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What are the main signs that can be observed in the nails?

finger clubbing
leuconychia
koilonychia

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What are the main GI causes of finger clubbing?

IBD
cirrhosis
lymphoma
coecliac disease

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What can be observed in the arms in a GI exam?

Brusing (CLD)
IVDU marks - risk of Hep B and C

What can be observed in the wrists in a GI exam?

Flapping tremor (asterixis)
radial pulse

What are the main signs that can present in the face?

Cushingoid (moon face, plethora, acne, hiruste)
Parotid enlargement
Lymph nodes

What can be observed in the eyes?

scleral icterus
corneal arcus + zanthelasma
Episcleritis/conjuncitivs
Conjunctival pallor
Kayer-Fisher rings

What are Kayer-Fisher rings associated with?

Wilson’s disease

What are conjunctivits and episcleritis associated with?

IBD

What can be observed by looking in the mouth?

Angular stomatitis
Oral candidasis
Apthous ulcers
Fetor hepaticus

What is this sign and what does it indicate

angular stomatis

Iron/folate/b12 deficiency

What is oral candidiasis a sign of?

immunocompromised

What are apthous ulcers a sign of?

IBD - Crohns

What is fector hepaticus a sign of?

Breath has a strong musky smell Hepatic failure

What signs can be observed on the chest and back?

* Gynaecomastia * Loss of secondary sexual hair * SPider naevi * Abdominal distension * caput medusa * scars

What areas should be palpated for?

* all 9 areas - superficial and deep * Liver * Spleen * Kidneys * AAA

What is the liver being inspected for?

heptomgaly

How do you assess for ascites

* percuss away from the midline towards the left flank * leave finger at first point of dullness * roll patient towards you and percuss again

What should be asuculated in a GI exam?

* bowel sounds * renal bruits * liver bruit if left liver edge is felt

What signs can be observed in the legs?

* peripheral oedema - CLD * Erythema nodosum * Pyoderma gangrenosum

What tests should be offered for completion

* groin/hernia * external genitalia * DRE * urine dipstick * observation chart

What is Murphy's sign

Murphy's sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner's hand, Murphy's sign is positive.

What is Rovsing's sign?

Rovsing’s sign is a clinical finding that is indicative of acute appendicitis (the inflammation and possible infection of the appendix). A positive Rovsing’s sign is characterized by right lower abdominal pain upon palpation of the left side of the lower abdomen.

What are the main causes of splenomegaly

* Malaria * Myelofibrosis * CML * Infetcive endocarditis * RA

What are the main causes of Heptomegaly

* Infection; viral hepatitis, EBV, malaria, hepatic abscess * Infiltration; sarcoid, amyloid * Blood-related; lymphoma, leukamia, myoprolifertaive disorders, haemolytic anaemia * Biliary; PBC, PSC * Cancer * Congetsion; RHF, tricuspid regurgitation, Budd-Chiari syndrome

What is Budd-Chiari syndrome

Budd-Chiari syndrome (BCS) is an uncommon disorder characterized by obstruction of hepatic venous outflow. The obstruction may be thrombotic or non-thrombotic anywhere along the venous course from the hepatic venules to junction of the inferior vena cava (IVC) to the right atrium.

What are some of the main causes of gynaecomastia?

* physiological (elderly/puberty) * Testicular failure * Klinefelter's dynrome * viral orchitis/testicular trauma * haemodialysis * Increased oestrogen * Chronic liver disease * thyrotoxicis * oestrogen-secretung tumour * Drug induced