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Differentials > Gastrointestinal Symptoms and Signs > Flashcards

Gastrointestinal Symptoms and Signs Flashcards

1
Q

Unintentional weight loss over weeks or months

A
  • Any advanced malignancy
  • pyschiatric illness mainly severe depression)
  • non-malignant GI diseases
  • alcoholism
  • undiagnosed or uncontrolled DM
  • thyrotoxicosis
  • pulmonary TB
  • addision’s disease
  • other (acute infections, neurological disease, connective tissue disease)
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2
Q

Weight gain

A
  • Excessive caloric intake (95%, often with mild depression)
  • drugs (steroids, NSAIDS, sulphonlyureas, insulin, oestrogen etc)
  • congestive cardiac failure
  • hypothyroidism
  • premenstrual fluid retention
  • polycystic ovary syndrome
  • pregnancy
  • liver cirrhosis with ascites
  • nephrotic syndrome
  • cushing’s syndrome with ACTH secreting tumour
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3
Q

Vomiting

A

Non-specific if lone presentation

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4
Q

Vomiting with weight loss

A
  • oesophageal stricture
  • oesophageal carcinoma
  • gastric carcinoma
  • small intestinal tumour (eg lymphoma)
  • achalasia
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5
Q

Vomiting without weight loss

A
  • oesophagitis and ulceration
  • pharyngeal pouch
  • achalasia
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6
Q

Vomiting shortly after food

A
  • gastritis/peptic ulcer disease (duodenal ulcer or gastric ulcer)
  • gastric outlet obstruction
  • small intestinal tumour
  • gastroparesis due to DM
  • acute cholycystitis
  • acute pancreatitis
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7
Q

Vomiting with abdo pain and fever

A
  • gastroenteritis (live microbes)
  • food poisoning (toxins of dead microbes)
  • UTI with/without pyelonephritis
  • acute appendicitis
  • mesenteric adenitis (non-specific abdo pain)
  • hep A or B
  • toxic shock syndrome
  • lower lobe pneumonia
  • pelvic inflammatory disease
  • haemolytic uraemic syndrome
  • malaria
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8
Q

Vomiting with abdo pain alone (unrelated to food and no fever) - non-metabolic causes

A
  • large bowel obstruction
  • hepatic carcinoma primary or secondary
  • mesenteric artery occlusion
  • renal calculi
  • ectopic pregnancy
  • acute inferior MI
  • congestive cardiac failure
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9
Q

Vomiting with abdo pain alone (unrelated to food and no fever) - metabolic causes

A
  • drug overdose
  • diabetic ketoacidosis
  • hypercalcaemia
  • addison’s disease
  • acute intermittent porphyria
  • phaeochromocytoma
  • lead poisoning
  • vitamin A intoxification
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10
Q

Vomiting with headache alone (unrelated to food and no abdo pain)

A
  • gastroenteritis
  • acute viral labyrinthitis
  • drugs
  • sliding hiatus hernia
  • chronic renal failure
  • pregnancy (hyperemesis gravidarum)
  • Meniere’s disease
  • acute otitis media (children)
  • anaphylaxis
  • functional
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11
Q

Jaundice

A
  • carotinaemia
  • pre-hepatic jaundice (haemolytic)
  • haemolytic (congenital enzyme defect)
  • hepatocellular jaundice (hepatic with element of obstructive)
  • obstructive jaundice
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12
Q

Pre-hepatic jaundice due to haemolysis

A
  • hereditary haemolytic anaemia
  • acquired haemolytic anaemia
  • septicaemic haemolysis
  • malaria
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13
Q

Hepatic jaundice due to congenital enzyme defect

A
  • Gilbert’s syndrome

- Crigler-Najjar syndrome (type 1 or 2)

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14
Q

Hepatocellular jaundice (due to hepatitis or very severe liver failure)

A
  • drug induced hepatitis
  • acute (viral) hepatitis A
  • acute hepatitis B
  • acute hepatitis C
  • alcoholic hepatitis
  • primary hepatoma
  • right heart failure, glandular fever
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15
Q

Obstructive jaundice

A
  • common bile duct stones
  • pancreatic head cancer
  • sclerosing cholangitis
  • PBC
  • drug-induced
  • pregnancy (third trimester)
  • alcholic hepatitis or cirrhosis
  • Dubin-Johnson syndrome
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16
Q

Dysphagia for solids which stick

A
  • oesophageal stricture
  • oesophageal carcinoma
  • carcinoma of cardia of stomach
  • external oesophageal compression
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17
Q

Dysphagia for solids > liquids

A
  • globus pharyngeus
  • xerostomia
  • pharyngeal pouch
  • post-cricoid web
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18
Q

Sore throat

A
  • viral pharyngitis
  • acute follicular tonsillitis
  • infectious mononucleosis
  • candadiasis of buccal or oesophageal mucosa
  • agranulocytosis
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19
Q

Dysphagia for fluids > solids

A
  • pseudobulbar palsy
  • scleroderma
  • bulbar palsy
  • myasthenia gravis
  • motor neurone disease
  • diffuse oesophageal spasm (intermittent)
  • achalasia (progressive)
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20
Q

Acute pain in the upper abdomen

A
  • gallstone colic (with no acute inflammation or infection)
  • acute cholecystitis
  • acute pancreatitis
  • acute cholangitis
  • gastric carcinoma
  • gastritis
  • oesophagitis
  • hiatus hernia
  • ACS
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21
Q

Acute central abdo pain

A
  • small bowel obstruction
  • abdominal aortic dissection
  • crohn’s disease
  • mesenteric artery occlusion
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22
Q

Acute lateral abdo pain

A
  • appendicitis
  • pyelonephritis
  • renal calculus
  • ureteric calculus
  • salpingitis
  • ruptured ovarian cyst
  • torsion
  • endometriosis
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23
Q

Acute lower central abdo pain (hypogastric)

A
  • cystitis due to bacterial infection
  • pelvic inflammatory disease
  • pelvic endometriosis
  • ectopic pregnancy
  • large bowel obstruction
  • infective or ulcerative colitis
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24
Q

Acute abdo pain in children

A
  • gastroenteritis
  • infantile colic
  • mesenteric adenitis
  • UTI
  • intussusception
  • acute appendicitis
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25
Q

Recurrent abdo pain in children

A
  • recurrent viral illness
  • psychosomatic cause
  • constipation
  • recurrent UTI
  • IBS
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26
Q

Sudden diarrhoea, fever and vomiting

A
  • viral gastroenteritis (usually norovirus)
  • rotavirus
  • antibiotic-induced bacterial opportunists
  • food poisoning/toxins
  • Clostridium perfringens
  • Staphylococcus aureus
  • Bacillus cereus
  • Vibrio para haemolyticus
  • botulism
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27
Q

Recurrent diarrhoea with blood and/or mucus

A
  • crohn’s disease
  • ulcerative colitis
  • colonic carcinoma
  • colorectal carcinoma
  • diverticular disease/diverticulitis
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28
Q

Acute bloody diarrhoea with/without mucus

A
  • Campylobacter enteritis
  • Shigella dysentry
  • enteroinvasive E. coli
  • enterohaemorrhagic type 0157 E.coli
  • Entamoeba histolytica dysentry
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29
Q

Watey diarrhoea

A
  • traveller’s diarrhoea
  • enterotoxigenic E coli
  • Vibrio cholera
  • Rotavirus
  • Norwalk virus
30
Q

Recurrent diarrhoea with no blood in stools, no fever

A
  • IBS
  • faecal impaction with overflow
  • malabsorption
  • drug-induced
  • HIV infection
  • diabetic autonomic neuropathy
  • thyrotoxicosis
  • carcinoid syndrome
31
Q

Chronic diarrhoea in children

A
  • lactose intolerance
  • cow’s milk protein intolerance
  • chronic infection of bowel
  • coeliac disease
  • cystic fibrosis
  • IBS
32
Q

Constipation

A
  • change in diet
  • change in lifestyle or environment
  • immobility
  • drug-induced
  • anal fissure
  • haemorrhoids
  • poor fluid intake
  • hypothyroidism
  • rectal tumour
  • colonic carcinoma
33
Q

Change in bowel habit

A
  • change in diet
  • colonic carcinoma
  • drug-induced
  • depression
  • immobility
  • cerebral or spinal cord lesion
  • metabolic disturbances (hypothyroidism, hyperthyroidism, hypercalcaemia, hypocalcaemia
34
Q

Haematemesis with/without melaena

A
  • bleeding duodenal ulcer
  • bleeding gastric ulcer
  • gastric erosion
  • oesophageal varices
  • Mallory-Weiss tear
  • oesophageal carcinoma
  • gastric carcinoma
  • GORD
  • hiatus hernia
  • ingestion of corrosives
  • Meckel’s diverticulum
  • false haematemesis
35
Q

Passage of blood per rectum

A
  • bleeding haemarrhoids
  • anal fissure
  • diverticulitis
  • rectal carcinoma
  • colonic carcinoma
  • ulcerative colitis
  • massive upper GI bleed
  • Crohn’s disease
  • Meckel’s diverticulum
  • trauma
  • intussusception
36
Q

Tenesmus

A
  • rectal inflammation (proctitis)
  • rectal tumour
  • tumour of descending colon
  • pelvic inflammatory disease
37
Q

Anorectal pain

A
  • anal fissure
  • haemorrhoids
  • perianal abscess
  • proctalgia fugax (coccydynia)
  • proctitis
  • prostatitis (referred pain)
38
Q

Distended abdomen

A
  • fat (obesity)
  • fluid (ascites)
  • flatus (gas)
  • small bowel obstruction
  • large bowel obstruction
  • splenic rupture
  • faecal impaction
  • fibroids
  • large ovarian cyst
  • foetus
39
Q

Distended abdominal veins

A
  • portal hypertension
  • superior vena cava obstruction
  • inferior vena cava obstruction
40
Q

Abdominal bruising

A
  • retroperitoneal haemorrhage
  • abdominal aortic aneurysm (ruptured or dissecting)
  • splenic rupture
41
Q

Poor abdominal movement

A
  • small bowel obstruction
  • large bowel obstruction
  • peritonitis
42
Q

Localised tenderness in suprapubic region

A
  • acute bladder distension

- cystitis

43
Q

Localised tenderness in upper right quadrant

A
  • acute cholecystitis
  • acute alcoholic hepatitis
  • acute viral hepatitis
  • acute liver congestion
44
Q

Localised tenderness in upper left quadrant

A
  • pyelonephritis
  • splenic rupture
  • splenic infarct
45
Q

Localised tenderness in umbilical region

A
  • gastritis
  • duodenal ulcer
  • gastric ulcer
  • pancreatitis
  • small bowel infarction
  • abdominal aortic aneurysm (ruptured or dissecting)
46
Q

Localised tenderness in the left or right loin

A
  • pyelonephritis
  • renal calculus
  • abdominal aortic aneurysm (ruptured or dissecting)
47
Q

Localised tenderness in left or right lower quadrant

A
  • appendicitis
  • diverticulitis
  • mesenteric adentitis
  • ectopic pregnancy
48
Q

Hepatomegaly - smooth and tender

A
  • alcoholic hepatitis
  • infectious hepatitis
  • glandular fever
  • right heart failure
  • tricuspid regurgitation with right heart failure
49
Q

Hepatomegaly - smooth but not tender

A
  • cirrhosis of the liver (early and fatty change)
  • lymphoma (Hodgkin’s or non-Hodgkin’s)
  • leukaemia
  • haemochromatosis
  • PBC
  • Amyloidosis in kidneys, heart, nerves, gut, liver, primary or secondary to rheumatoid, IBS, TB etc
50
Q

Hepatomegaly - irregular, not tender

A
  • metastatic carcinoma
  • hepatoma
  • hydatid cyst
51
Q

Splenomegaly - slight

A
  • glandular fever
  • Brucella
  • hepatitis A, B, C or D
  • bacterial endocarditis
  • Amyloidosis in kidneys, heart, nerves, gut, liver, primary or secondary to rheumatoid, IBS, TB etc
  • haemolytic anaemia
52
Q

Splenomegaly - moderate

A
  • lymphoma (Hodgkin’s or non-Hodgkin’s)
  • chronic leukaemia
  • cirrhosis with/without portal hypertension
53
Q

Splenomegaly - massive

A
  • chronic myeloid leukaemia
  • myelofibrosis
  • malaria
  • kala-azar (visceral leishmaniasis)
54
Q

Bilateral masses in upper abdomen

A
  • polycystic renal disease
  • bilateral hydronephroses
  • Amyloidosis in kidneys, heart, nerves, gut, liver, primary or secondary to rheumatoid, IBS, TB etc
55
Q

Unilateral mass in left or right upper quadrant

A
  • renal carcinoma
  • unilateral hydronephrosis
  • renal cyst
  • distended gall bladder (on right side)
56
Q

Mass in epigastrium

A
  • gastric carcinoma
  • carcinoma of pancreas
  • aortic aneurysm
57
Q

Mass in right lower quadrant

A
  • appendix
  • Crohn’s granuloma
  • carcinoma of caecum
  • transplanted kidney
58
Q

Mass in suprapubic region

A
  • distended bladder
  • pregnant uterus
  • uterine fibroid
  • uterine neoplasm
  • ovarian cyst
59
Q

Mass in left lower quadrant

A
  • diverticular abscess
  • carcinoma of descending or sigmoid colon
  • faecal impaction
60
Q

Central dullness, resonance in flank

A
  • distended bladder
  • pregnant uterus
  • massive ovarian cyst
61
Q

Shifting dullness

A
  • carcinomatosis with spread to peritoneum
  • cirrhosis
  • congestive cardiac failure
  • nephrotic syndrome
62
Q

Silent abdomen with no bowel sounds

A
  • peritonitis eg. due to bowel perforation

- bowel infarction (due to embolus eg. from fibrillating atrium or atheroma)

63
Q

High-pitched bowel sounds

A
  • small bowel obstruction
  • large bowel obstruction
  • hernial orifice strangulation
  • sigmoid volvulus
  • IBS
  • faecal impaction
64
Q

Abdominal/loin bruit

A
  • aortic aneurysm
  • renal artery stenosis
  • dissecting aorta
65
Q

Lump in the groin

A
  • lymph node inflammation
  • inguinal hernia
  • femoral hernia
  • strangulated hernia
  • lymphoma (Hodgkin’s or non-Hodgkin’s)
  • femoral artery aneurysm
  • Saphena varix (dilatation of long saphenous vein in the groin)
  • cold abscess of psoas sheath
66
Q

Scrotal swelling

A
  • inguinal hernia descended into scrotum
  • hydrocoele
  • epididymal cyst
  • testicular torsion
  • haematocoele
  • varicocoele (90% on the left)
  • acute epididymitis
  • chronic epididymitis
  • spermatocoele
  • seminoma
  • teratoma
67
Q

Anal swelling

A
  • prolapsed internal haemorrhoids
  • acute anal fissure
  • spontaneous perianal haematoma
  • perianal abscess
  • rectal prolapse
68
Q

Enlargement of prostate

A
  • prostatitis
  • benign prostatic hypertrophy
  • prostatic carcinoma
69
Q

Melaena on finger

A
  • bleeding duodenal ulcer
  • bleeding gastric ulcer
  • gastric erosion
  • oesophageal varices
  • Mallory-Weiss tear
  • oesophageal carcinoma
  • gastric carcinoma
  • GORD
  • hiatus hernia
  • ingestion of corrosives
  • Meckel’s diverticulum
  • false haematemesis
  • bleeding diathesis
  • angiodysplasia
70
Q

Fresh blood on finger on rectal examination

A
  • haemorrhoids
  • rectal carcinoma
  • colonic carcinoma
  • ulcerative colitis
  • angiodysplasia
  • diverticulitis
  • ischaemic colitis
  • Meckel’s diverticulum
  • intussesception
  • mesenteric infarction (acute occlusion)
  • massive upper GI bleed
  • Crohn’s disease
  • trauma

Differentials (6 decks)

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