Gastrointestinal System

Question 1

What would a history of bilary colic be like?

Answer 1

• Intermittent RUQ/epigastric pain (minutes/hours) into back or right shoulder
• Nausea and vomiting

Question 2

What would you find on examination of biliary colic?

Answer 2

• Tender RUQ
• NO pyrexia, peritonism or murphys
• HR and blood pressure will be normal

Question 3

What would blood tests of bilary colic show?

Answer 3

• Normal WCC, CRP and LFTs

Question 4

What would history of acute colecystitis show?

Answer 4

• Constant RUQ pain into back or right shoulder
• nausea and vomiting
• feverish

Question 5

What would examination of acute cholecystitis reveal?

Answer 5

• Tender RUQ
• Peritonism in RUQ (guardin/rebound)
• Positive murphys
• pyrexia and increased HR

Question 6

What would blood tests in acute cholecystitis show?

Answer 6

• Increased WCC and CRP
• either normal or mildly increased LFTs

Question 7

What would an examination of empyema reveal?

Answer 7

• Constant RUQ pain into back or right shoulder
• N&V
• Feverish

Question 8

What would examination of emyema (as a complication of gallstones) reveal?

Answer 8

• Tender RUQ
• Peritonism in RUQ
• Murphys sign positive
• increased HR, pyrexia and either normal or low BP
• More septic than acute cholecystitis

Question 9

What would blood tests of empyema reveal?

Answer 9

• raised WCC and CRP
• LFTs either normal or mildly raised

Question 10

What would a history on obstructive jaundice reveal?

Answer 10

• yellow discolouration
• pale stool
• dark urine
• painless or associated with mild RUQ pain

Question 11

What would examination of obstructive jaundice reveal?

Answer 11

• jaundice
• non-tender/minimally tender RUQ
• NO: peritonism, murphys sign or pyrexia
• normal HR and BP

Question 12

What would blood tests results show in a case of obstructive jaundice?

Answer 12

• normal WCC and CRP
• INR would be normal or slightly raised
• LFTs would show an obstructive pattern bilirubin
  
  • ALP and GGT would be increased
  • ALT/AST would be normal

Question 13

What would the history of ascending cholangitis reveal?

Answer 13

• Charcots triad (100% of time)
  
  • RUQ pain (constant)
  • Jaundice
  • Fever, usually with rigors

Question 14

What would examination of ascending cholangitis reveal?

Answer 14

• Jaundiced
• tender RUQ
• peritonism RUQ
• spiking high pyrexia e.g. 38-39
• increased HR and normal or low BP
• PTs can develop septic shock!!

Question 15

What would blood test of ascending cholangitis reveal?

Answer 15

• raised WCC and CRP
• LFTs would show an obstructive pattern bilirubin
  
  • also
    
    • increased ALP and GGT
    • normal ALT/AST
• Normal or raised INR

Question 16

What would examination of acute pancreatitis reveal?

Answer 16

• Severe upper abdominal pain (constant) into back
• profuse vomiting

Question 17

What would examination of acute pancreatitis reveal?

Answer 17

• tender upper abdomen
• upper abdominal or generalised peritonism
• usually apyrexial
• increased HR, normal or dc BP

Question 18

What would blood tests reveal in acute pancreatitis?

Answer 18

• Raised WCC and CRP
• LFTs would be normal if passed stone
  
  • or obstructive pattern if stone is still in common bile duct
• Amylase would be high
• INR/APTT(clotting) would be normal OR raised IF D.I.C

Question 19

What would examination reveal in gallstone ileus?

Answer 19

• the 4 cardinal features of small bowel obstruction
  
  • pain
  • vomiting
  • obstipation
  • abdo distension

Question 20

What would examination reveal in gallstone ileus?

Answer 20

• Distended tympanic abdomen
• hyperactive/tinkling bowel sounds