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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
Recurrent abdo pain in children
- recurrent viral illness - psychosomatic cause - constipation - recurrent UTI - IBS
26
Sudden diarrhoea, fever and vomiting
- viral gastroenteritis (usually norovirus) - rotavirus - antibiotic-induced bacterial opportunists - food poisoning/toxins - Clostridium perfringens - Staphylococcus aureus - Bacillus cereus - Vibrio para haemolyticus - botulism
27
Recurrent diarrhoea with blood and/or mucus
- crohn's disease - ulcerative colitis - colonic carcinoma - colorectal carcinoma - diverticular disease/diverticulitis
28
Acute bloody diarrhoea with/without mucus
- Campylobacter enteritis - Shigella dysentry - enteroinvasive E. coli - enterohaemorrhagic type 0157 E.coli - Entamoeba histolytica dysentry
29
Watey diarrhoea
- traveller's diarrhoea - enterotoxigenic E coli - Vibrio cholera - Rotavirus - Norwalk virus
30
Recurrent diarrhoea with no blood in stools, no fever
- IBS - faecal impaction with overflow - malabsorption - drug-induced - HIV infection - diabetic autonomic neuropathy - thyrotoxicosis - carcinoid syndrome
31
Chronic diarrhoea in children
- lactose intolerance - cow's milk protein intolerance - chronic infection of bowel - coeliac disease - cystic fibrosis - IBS
32
Constipation
- change in diet - change in lifestyle or environment - immobility - drug-induced - anal fissure - haemorrhoids - poor fluid intake - hypothyroidism - rectal tumour - colonic carcinoma
33
Change in bowel habit
- change in diet - colonic carcinoma - drug-induced - depression - immobility - cerebral or spinal cord lesion - metabolic disturbances (hypothyroidism, hyperthyroidism, hypercalcaemia, hypocalcaemia
34
Haematemesis with/without melaena
- 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
Passage of blood per rectum
- bleeding haemarrhoids - anal fissure - diverticulitis - rectal carcinoma - colonic carcinoma - ulcerative colitis - massive upper GI bleed - Crohn's disease - Meckel's diverticulum - trauma - intussusception
36
Tenesmus
- rectal inflammation (proctitis) - rectal tumour - tumour of descending colon - pelvic inflammatory disease
37
Anorectal pain
- anal fissure - haemorrhoids - perianal abscess - proctalgia fugax (coccydynia) - proctitis - prostatitis (referred pain)
38
Distended abdomen
- fat (obesity) - fluid (ascites) - flatus (gas) - small bowel obstruction - large bowel obstruction - splenic rupture - faecal impaction - fibroids - large ovarian cyst - foetus
39
Distended abdominal veins
- portal hypertension - superior vena cava obstruction - inferior vena cava obstruction
40
Abdominal bruising
- retroperitoneal haemorrhage - abdominal aortic aneurysm (ruptured or dissecting) - splenic rupture
41
Poor abdominal movement
- small bowel obstruction - large bowel obstruction - peritonitis
42
Localised tenderness in suprapubic region
- acute bladder distension | - cystitis
43
Localised tenderness in upper right quadrant
- acute cholecystitis - acute alcoholic hepatitis - acute viral hepatitis - acute liver congestion
44
Localised tenderness in upper left quadrant
- pyelonephritis - splenic rupture - splenic infarct
45
Localised tenderness in umbilical region
- gastritis - duodenal ulcer - gastric ulcer - pancreatitis - small bowel infarction - abdominal aortic aneurysm (ruptured or dissecting)
46
Localised tenderness in the left or right loin
- pyelonephritis - renal calculus - abdominal aortic aneurysm (ruptured or dissecting)
47
Localised tenderness in left or right lower quadrant
- appendicitis - diverticulitis - mesenteric adentitis - ectopic pregnancy
48
Hepatomegaly - smooth and tender
- alcoholic hepatitis - infectious hepatitis - glandular fever - right heart failure - tricuspid regurgitation with right heart failure
49
Hepatomegaly - smooth but not tender
- 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
Hepatomegaly - irregular, not tender
- metastatic carcinoma - hepatoma - hydatid cyst
51
Splenomegaly - slight
- 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
Splenomegaly - moderate
- lymphoma (Hodgkin's or non-Hodgkin's) - chronic leukaemia - cirrhosis with/without portal hypertension
53
Splenomegaly - massive
- chronic myeloid leukaemia - myelofibrosis - malaria - kala-azar (visceral leishmaniasis)
54
Bilateral masses in upper abdomen
- polycystic renal disease - bilateral hydronephroses - Amyloidosis in kidneys, heart, nerves, gut, liver, primary or secondary to rheumatoid, IBS, TB etc
55
Unilateral mass in left or right upper quadrant
- renal carcinoma - unilateral hydronephrosis - renal cyst - distended gall bladder (on right side)
56
Mass in epigastrium
- gastric carcinoma - carcinoma of pancreas - aortic aneurysm
57
Mass in right lower quadrant
- appendix - Crohn's granuloma - carcinoma of caecum - transplanted kidney
58
Mass in suprapubic region
- distended bladder - pregnant uterus - uterine fibroid - uterine neoplasm - ovarian cyst
59
Mass in left lower quadrant
- diverticular abscess - carcinoma of descending or sigmoid colon - faecal impaction
60
Central dullness, resonance in flank
- distended bladder - pregnant uterus - massive ovarian cyst
61
Shifting dullness
- carcinomatosis with spread to peritoneum - cirrhosis - congestive cardiac failure - nephrotic syndrome
62
Silent abdomen with no bowel sounds
- peritonitis eg. due to bowel perforation | - bowel infarction (due to embolus eg. from fibrillating atrium or atheroma)
63
High-pitched bowel sounds
- small bowel obstruction - large bowel obstruction - hernial orifice strangulation - sigmoid volvulus - IBS - faecal impaction
64
Abdominal/loin bruit
- aortic aneurysm - renal artery stenosis - dissecting aorta
65
Lump in the groin
- 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
Scrotal swelling
- inguinal hernia descended into scrotum - hydrocoele - epididymal cyst - testicular torsion - haematocoele - varicocoele (90% on the left) - acute epididymitis - chronic epididymitis - spermatocoele - seminoma - teratoma
67
Anal swelling
- prolapsed internal haemorrhoids - acute anal fissure - spontaneous perianal haematoma - perianal abscess - rectal prolapse
68
Enlargement of prostate
- prostatitis - benign prostatic hypertrophy - prostatic carcinoma
69
Melaena on finger
- 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
Fresh blood on finger on rectal examination
- 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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