Gastrointestinal System Flashcards by Lian Dimaro

Ddx Dupytrens contacture

CLD, diabetes, heavy labour, phenytoin, trauma, familial

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Ddx Palmer erythema

CLD, pregnancy, hyperthyroidism, RA

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Ddx finger clubbing

IBD, Cirrhosis, lymphoma, coeliac disease

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Ddx leuconychia

Hypoalbuminaemia - CLD and other causes

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Ddx koilonychia

Iron-deficiency anaemia e.g GI bleed

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Ddx flapping tremor

Hepatic failure, respiratory/ renal failure

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Bruising

CLD - thrombocytopenia, clotting factors, falls

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Ddx cushingoid features

Alcohol abuse, long term steroids, Cushings disease

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Signs and indications in the eyes

Scleral icterus - jaundice (implies serum bilirubin > 35 micromol/l)

Corneal arcus & xanthelasma - hyperlipidaemia (PBC & cholestasis)

Episcleritis / conjunctivitis - IBD

Conjunctival pallor - anaemia

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Signs and indications in the mouth

Angular stomatitis & glossitis - iron/ folate/ B12 deficiency

Oral candidiasis - immunodeficiency or steroids

Apthos ulcers - IBD (esp Crohns)

Fentor helaticus - hepatic failure (mercaptan accumulation)

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Ddx gynaeconastia

CLD, drugs, testicular failure

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How do you confirm spider naevi, what distribution do they follow?

Depress to demonstrate filling - occur in distribution of SV. More than 5 suggest CLD

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Causes of abdominal distension

6Fs -Fat, fluid, flatus, faeces, fetus, flipping big masses (Ca)

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What does shifting dullness indicate?

Ascites - > 1.5l fluid present (fluid and dullness shifts with gravity)

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Ddx peripheral oedema

CLD and other causes - RHF, lung fibrosis

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Other than oedema, what other GI sign might you see in the legs and what are these indicative of?

Erythema nodusum (IBD) and pyoderma gangrenosum (IBD, RA)

Concluding remarks

Examine groins (hernia), genitalia (testicular atrophy in CLD), perform PR exam

Obs chart (BP, temp, SaO2)

Ddx ascites - transudate

CLD
RHF
Volume overload
Hypoalbuminaemia
Constrictive pericarditis

Ddx ascites - exudate

Infection - spontaneous bacterial peritonitis, TB

Inflammation - pancreatitis

Malignancy - luminal (stomach/ colon), pancreas, liver, ovarian, lymphoma

Ddx hepatomegaly

2 Is, 2 Bs, 2 Cs

Infection - viral hepatitis, EBV, Malaria, hepatic abscess

Infiltration - sarcoid, amyloid, fatty liver, haemochromatosis

Blood related - lymphoma, leukaemia, myeloproliferative disorders, haemolytic anaemia

Biliary - PBC, PSC

Cancer - primary HCC, Metastatic deposits

Congestion - RHF, tricuspid regurgitation, Budd- Chiari syndrome

Ddx hepatosplenomegaly

Infection - viral hepatitis, EBV, Malaria, hepatic

Infiltration - sarcoid, amyloid, fatty liver, haemochromatosis

Blood related - lymphoma, leukaemia, myeloproliferative disorders, haemolytic anaemia

Extra-intestinal signs of IBD

Finger clubbing
Mouth ulcers (esp Crohns)
Eyes - episcleritis &amp; conjunctivitis
Skin - erythema nodosum, pyoderma gangrenosum
Joints - serinegative spondylarthropathy
PSC (esp UC)
Amyloidosis (esp Crohns)

Ddx gynaecomastia

Physiological (puberty/ elderly)
Testicular failure (kleinfelters, trauma, viral orchitis, haemodialysis)
Increase oestrogen (CLD, thyrotoxicosis, oestrogen inducing tumour)
Drug induced (digoxin, isoniazid, Spiro)

Causes of massive splenomegaly

Malaria
Myelofibrosis
chronic Myeloid leukaemia

Other causes of splenomegaly

Infective endocarditis, RA

Signs of portal hypertension

Capitol medusae, oesvageal varices, gastropathy, & ascites

Ddx smooth liver edge

Venous congestion | Fatty infiltration

Ddx knobbly liver edge

Metastases | Cysts

Ddx pulsatile liver edge

Tricuspid regurgitation

Ddx tender liver edge

Hepatitis | RHF (capsular pain)

Ddx of liver edge Bruit

HCC AV malformation TIPPS (transjugular intrahepatic Porto-systemic shunt

How could you differentiate between spleen and left kidney?

``` You get your hand over a kidney Percussion note is resonant over kidney Kidney is balottable Spleen has a notch Spleen moves more on respiration ```

Ddx tendon Xanthomata

hyperlipidaemia (PBC, cholestasis)

Ddx lower right quadrant pain

``` Appendicitis Intestinal obstruction Regional enteritis Diverticulitis Cholecystitis Ectopic pregnancy Ovarian cyst or torsion Endometriosis Salpingitis Uterical calculi Seminal vesiculitis Psoas abscess ```

Ddx lower left quadrant pain

``` Diverticulitis Intestinal obstruction Appendicitis Ectopic pregnancy Ovarian cyst or torsion Endometriosis Salpingitis Uterical calculi Seminal vesiculitis Psoas abscess ```

Ddx left upper quadrant pain

``` Gastritis Pancreatitis Splenic enlargement, rupture, infarction Renal pain Herpes zoster MI Pneumonia Empyema ```