Gastrointestinal examination signs Flashcards
Clinical signs from the end of the bed
- age
- confusion
- pain
- obvious scars
- abdominal distension
- pallor
- jaundice
- hyperpigmentation
- oedema
- cachexia
- hernias
Objects and equipment to look out for?
- stoma bags
- surgical drains
- feeding tubes
- other medical equipment
- mobility aids
- vital signs
- fluid balance
- prescriptions
What are you looking for on the palms of the hands?
- pallor
- palmar erythema
- dupuytren’s contracture
Why is considering age helpful?
younger patients are more likely to have diagnoses such as IBD
older patients are more likely to have chronic liver disease and malignancy
What can confusion be a feature of?
end-stage liver disease, known as hepatic encephalopathy
What can abdominal distension suggest?
underlying anaemia (e.g. gastrointestinal bleeding or malnutrition).
What can jaundice be a sign of?
acute pancreatitis, liver cirrhosis, cholangitis, pancreatic cancer
What is hyperpigmentation and what is it associated with?
a bronzing of the skin associated with haemochromatosis
What is oedema typically associated with in a GI exam?
liver cirrhosis
What is cachexia?
ongoing muscle loss that is not entirely reversed with nutritional supplementation.
What is cachexia commonly associated with?
Underlying malignancy (e.g. pancreatic/ bowel/ stomach cancer) and advanced liver failure.
How can you make hernias more pronounced?
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.
Palms: what can pallor suggest?
May suggest underlying anaemia
e.g. malignancy, gastrointestinal bleeding, malnutrition
Palms: what is palmar erythema and what can it be associated with?
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)
Nail signs
- koilonychia
- leukonychia
What is koilonychia and what is it associated with?
spoon-shaped nails, associated with iron deficiency anaemia (e.g. malabsorption in Crohn’s disease)
What is leukonychia and what is it associated with?
whitening of the nail bed, associated with hypoalbuminaemia (e.g. end-stage liver disease, protein-losing enteropathy)
What is finger clubbing most likely to be associated with in a GI exam?
- IBD
- coeliac disease
- liver cirrhosis
- lymphoma of the GI tract.
Asterixis (flapping tremor) most likely underlying causes
- hepatic encephalopathy (due to hyperammonaemia)
- uraemia secondary to renal failure.
CO2 retention secondary to type 2 respiratory failure is another possible cause of asterixis
What is dupuytren’s contracture?
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.
What are you looking for when inspecting the arms
- 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
What are you looking for in the axillae?
- acanthosis nigricans
- hair loss
What is acanthosis nigricans?
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).
What is hair loss associated with in the GI exam?
loss of axillary hair associated with iron-deficiency anaemia and malnutrition
