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Phase 2b Medicine > Gastrointestinal examination signs > Flashcards

Gastrointestinal examination signs Flashcards

1
Q

Clinical signs from the end of the bed

A
  • age
  • confusion
  • pain
  • obvious scars
  • abdominal distension
  • pallor
  • jaundice
  • hyperpigmentation
  • oedema
  • cachexia
  • hernias
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2
Q

Objects and equipment to look out for?

A
  • stoma bags
  • surgical drains
  • feeding tubes
  • other medical equipment
  • mobility aids
  • vital signs
  • fluid balance
  • prescriptions
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3
Q

What are you looking for on the palms of the hands?

A
  • pallor
  • palmar erythema
  • dupuytren’s contracture
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4
Q

Why is considering age helpful?

A

younger patients are more likely to have diagnoses such as IBD
older patients are more likely to have chronic liver disease and malignancy

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5
Q

What can confusion be a feature of?

A

end-stage liver disease, known as hepatic encephalopathy

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6
Q

What can abdominal distension suggest?

A

underlying anaemia (e.g. gastrointestinal bleeding or malnutrition).

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7
Q

What can jaundice be a sign of?

A

acute pancreatitis, liver cirrhosis, cholangitis, pancreatic cancer

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8
Q

What is hyperpigmentation and what is it associated with?

A

a bronzing of the skin associated with haemochromatosis

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9
Q

What is oedema typically associated with in a GI exam?

A

liver cirrhosis

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10
Q

What is cachexia?

A

ongoing muscle loss that is not entirely reversed with nutritional supplementation.

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11
Q

What is cachexia commonly associated with?

A

Underlying malignancy (e.g. pancreatic/ bowel/ stomach cancer) and advanced liver failure.

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12
Q

How can you make hernias more pronounced?

A

They may be visible from the end of the bed (e.g. umbilical/incisional hernia). Asking the patient to cough will usually cause hernias to become more pronounced.

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13
Q

Palms: what can pallor suggest?

A

May suggest underlying anaemia

e.g. malignancy, gastrointestinal bleeding, malnutrition

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14
Q

Palms: what is palmar erythema and what can it be associated with?

A

A redness involving the heel of the palm that can be associated with chronic liver disease (it can also be a normal finding in pregnancy)

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15
Q

Nail signs

A
  • koilonychia

- leukonychia

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16
Q

What is koilonychia and what is it associated with?

A

spoon-shaped nails, associated with iron deficiency anaemia (e.g. malabsorption in Crohn’s disease)

17
Q

What is leukonychia and what is it associated with?

A

whitening of the nail bed, associated with hypoalbuminaemia (e.g. end-stage liver disease, protein-losing enteropathy)

18
Q

What is finger clubbing most likely to be associated with in a GI exam?

A
  • IBD
  • coeliac disease
  • liver cirrhosis
  • lymphoma of the GI tract.
19
Q

Asterixis (flapping tremor) most likely underlying causes

A
  • hepatic encephalopathy (due to hyperammonaemia)
  • uraemia secondary to renal failure.

CO2 retention secondary to type 2 respiratory failure is another possible cause of asterixis

20
Q

What is dupuytren’s contracture?

A

It involves thickening of the palmar fascia resulting in the development of cords of palmar fascia which eventually cause contracture deformities of the fingers and thumb.

21
Q

What are you looking for when inspecting the arms

A
  • bruising: may suggest underlying clotting abnormalities secondary to liver disease (e.g. cirrhosis)
  • excoriations: scratch marks that may be caused by the patient trying to relieve pruritus. May suggest underlying cholestasis.
  • needle track marks: important to note as intravenous drug use can be associated with an increased risk of viral hepatitis
22
Q

What are you looking for in the axillae?

A
  • acanthosis nigricans

- hair loss

23
Q

What is acanthosis nigricans?

A

darkening (hyperpigmentation) and thickening (hyperkeratosis) of the axillary skin which can be benign (most commonly in dark-skinned individuals) or associated with insulin resistance (e.g. type 2 diabetes mellitus) or gastrointestinal malignancy (most commonly stomach cancer).

24
Q

What is hair loss associated with in the GI exam?

A

loss of axillary hair associated with iron-deficiency anaemia and malnutrition

25
Q

What signs are you looking for in the eyes?

A
  • conjunctival pallor
  • jaundice
  • corneal arcus
  • xanthelasma
  • kayser-fleischer rings
  • perilimbal injection
26
Q

What is perilimbal injection?

A

inflammation of the area of conjunctiva adjacent to the iris. Perilimbal injection is a sign of anterior uveitis, which can be associated with inflammatory bowel disease. Other clinical features of anterior uveitis include photophobia, ocular pain and reduced visual acuity.

27
Q

What signs are you looking for in the mouth?

A
  • angular stomatitis e.g. iron deficiency (gastrointestinal malignancy, malabsorption)
  • glossitis

Phase 2b Medicine (7 decks)

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