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Gastrointestinal > Gastrointestinal Examination > Flashcards

Gastrointestinal Examination Flashcards

1
Q

What are some of the core presenting symptoms

A
  • 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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2
Q

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

A
  • peptic ulcer disease
  • carcinoma
  • jaundice
  • hepatitis
  • blood tranfusions
  • tattoos
  • previous operations
  • last menstrual period
  • dietary changes
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3
Q

What are the 5 causes of distension?

A

Fat, Fluid, Faeces, Flatus, Fetus

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4
Q

What are the main GI causes of vomiting?

A
  • gastroenteritis
  • peptic ulcer
  • pyloric stenosis
  • intestinal obstruction
  • paralytic ileus
  • acute pancreatitis/cholecystitis
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5
Q

What are the main CNS causes of vomiting?

A
  • meningitis/encephalitis
  • migraine
  • increased ICP
  • brainstem lesion
  • motion sickness
  • Menieres disease
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6
Q

What are the main endocrine/metabolic causes of vomiting?

A
  • uraemia
  • hypercalcaemia
  • hyponatraemia
  • DKA
  • pregnancy
  • Addison’s
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7
Q

What is the general sequence of the abdominal examination?

A
  • 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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8
Q

What are the main causes of a transudate ascites

A

Low protein

  • Chronic Liver disease
  • RHF
  • VOlume overload
  • hypoalbuminaemia
  • constrictive perciarditis
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9
Q

What are the main causes of an exudate ascites?

A

high protein

  • Infection
  • Inflammation
  • Malignancy
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10
Q

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

A
  • general appearance (well/unwell)
  • Oxygen, drips, catheters, medications
  • Nutritional status, cachexia
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11
Q

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

A
  • Tendon xanthomata
  • Dupuytren’s contracture
  • Palar erythema
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12
Q

What is tendon xanthomata a sign of?

A

hyperlipidaemia (PBC, cholestasis)

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13
Q

What is dupuytren’s contracture a sign of?

A
  • Chronic liver disease
  • diabetes mellitus
  • heavy labour
  • phenytoin
  • trauma
  • familial
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14
Q

What is palmar erythema a sign of?

A
  • Chronic liver disease
  • pregnancy
  • hyperthyroidism
  • RA
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15
Q

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

A
  • finger clubbing
  • leuconychia
  • koilonychia
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16
Q

What are the main GI causes of finger clubbing?

A
  • IBD
  • cirrhosis
  • lymphoma
  • coecliac disease
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17
Q

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

A
  • Brusing (CLD)
  • IVDU marks - risk of Hep B and C
18
Q

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

A
  • Flapping tremor (asterixis)
  • radial pulse
19
Q

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

A
  • Cushingoid (moon face, plethora, acne, hiruste)
  • Parotid enlargement
  • Lymph nodes
20
Q

What can be observed in the eyes?

A
  • scleral icterus
  • corneal arcus + zanthelasma
  • Episcleritis/conjuncitivs
  • Conjunctival pallor
  • Kayer-Fisher rings
21
Q

What are Kayer-Fisher rings associated with?

A

Wilson’s disease

22
Q

What are conjunctivits and episcleritis associated with?

A

IBD

23
Q

What can be observed by looking in the mouth?

A
  • Angular stomatitis
  • Oral candidasis
  • Apthous ulcers
  • Fetor hepaticus
24
Q

What is this sign and what does it indicate

A

angular stomatis

Iron/folate/b12 deficiency

25
Q

What is oral candidiasis a sign of?

A

immunocompromised

26
Q

What are apthous ulcers a sign of?

A

IBD - Crohns

27
Q

What is fector hepaticus a sign of?

A

Breath has a strong musky smell

Hepatic failure

28
Q

What signs can be observed on the chest and back?

A
  • Gynaecomastia
  • Loss of secondary sexual hair
  • SPider naevi
  • Abdominal distension
  • caput medusa
  • scars
29
Q

What areas should be palpated for?

A
  • all 9 areas - superficial and deep
  • Liver
  • Spleen
  • Kidneys
  • AAA
30
Q

What is the liver being inspected for?

A

heptomgaly

31
Q

How do you assess for ascites

A
  • percuss away from the midline towards the left flank
  • leave finger at first point of dullness
  • roll patient towards you and percuss again
32
Q

What should be asuculated in a GI exam?

A
  • bowel sounds
  • renal bruits
  • liver bruit if left liver edge is felt
33
Q

What signs can be observed in the legs?

A
  • peripheral oedema - CLD
  • Erythema nodosum
  • Pyoderma gangrenosum
34
Q

What tests should be offered for completion

A
  • groin/hernia
  • external genitalia
  • DRE
  • urine dipstick
  • observation chart
35
Q

What is Murphy’s sign

A

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.

36
Q

What is Rovsing’s sign?

A

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.

37
Q

What are the main causes of splenomegaly

A
  • Malaria
  • Myelofibrosis
  • CML
  • Infetcive endocarditis
  • RA
38
Q

What are the main causes of Heptomegaly

A
  • 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
39
Q

What is Budd-Chiari syndrome

A

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.

40
Q

What are some of the main causes of gynaecomastia?

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

Gastrointestinal (4 decks)

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