GI Flashcards
What could a high pitched tinkling on bowel auscultation indicate?
Intestinal obstruction
Name 3 things that may cause visceral pain
- Distension
- Ischaemia
- Inflammation of an organ
How would you manage a patient with suspected appendicitis?
Urgent hospital admission
List 4 reasons why you may prefer an ultrasound over a CT scan?
- Less invasive
- No contrast
- Quicker
- Useful for solid organs/fluid filled structures
Where is the ascending colon located?
Midgut
What are the 5 Fs of abdominal distension?
Fat
Faeces
Flatus
Fetus
Fluid
What are 6 causes of an enlarged liver?
- Alcoholic liver disease
- Hepatitis/cirrhosis
- Primary Liver cancer
- Metastatic cancer
- Lymphoma
- Leukaemia
List 3 presenting features of colorectal cancer
- Weight loss
- Diffuse and intermittent pain
- Change in bowel habit
True or False - biliary colic normally lasts for 5-7 days
False
What are 3 risk factors for gastritis/oesophagitis?
Spicy Foods
NSAIDs
Alcohol
How might a patient with an anal fissure present?
Bright red blood after bowel movements
and
Severe pain on defection - like passing glass
Name the 9 regions of the abdomen
Right Hypochondriac
Epigastric
Left Hypochondriac
Right Lumbar
Umbilical
Left Lumbar
Right Iliac Fossa
Hypogastric
Left Iliac Fossa
What is the significance of the hind-gut, fore-gut, mid-gut breakdown?
If you know which part of the gut the pain FIRST started, this gives you an idea of which organs may be affected
What organs are in the fore-gut?
Oesophagus
Stomach
Liver
Gallbladder
Pancreas
D1 and D2
What organs are in the mid-gut?
D3 and D4
Jejenum
Ilium
Caecum
Appendix
Ascending colon
Half transverse colon
What organs are in the hind-gut?
Half transverse colon
Descending colon
sigmoid colon
rectum
upper anal canal
What are the 2 causes of abdominal pain which are medical emergencies and need to be ruled out quickly?
Ectopic Pregnancy
Ruptured AAA
How does diverticular disease typically present?
Left iliac fossa pain (sigmoid colon)
Pain is colicky - intermittent and resolves in waves
CBH - pellet like stools, but variable and intermittent
Occasional PR bleed
Occasional mucus
Diverticulitis… Sepsis
How does gastritis typically present? Include pain, associations, relieving factors and risk factors
Pain in the upper abdomen
Gradual onset of pain, intermittent
Can be gnawing or burning
Can radiate backwards
Mild to moderate Pain
Associated with belching and nausea
Eating can relieve pain
Risk factors: NSAIDs, spicy food, stress, alcohol
What is the difference between biliary colic and cholecystitis?
Both cause pain because of gall stones (small mass formed from bile).
Biliary colic - pain from the gall stones: temporary obstruction
Cholecystitis - inflammation and infection: the patient is unwell
When might pneumonia end up presenting with GI symptoms?
Lower lobe pneumonia can cause upper abdominal pain
How can you determine the difference between haemorrhoids or anal fissure?
Anal fissure pain is sharp and severe - like passing glass
Haemorrhoids are a more dull pain
Describe the symptoms of IBD
Often loose liquid stools
Increase frequency
Blood and mucus mixed in the stool
Abdominal Pain
Weight loss
Nausea
Why is smoking history important when assessing a person with GI symptoms?
It can be a protective factor in ulcerative colitis
List 7 clinical signs in the hands that may indicate a GI condition
Temperature: cold and sweaty = anxiety, cold and dry = poor circulation, hot and sweaty = hyperthyroidism, dry and coarse = hypothyroidism
Clubbing: chronic disease/IBD/liver disease
Leukonychia: chronic liver disease
Koilonychia: anaemia
Flaps: Liver disease
Palmar Erythema: liver disease
What is Virchow’s node - why is it significant in GI?
Palpable left supraclavicular lymph node…
Sign of upper GI malignancy
What are the 6 causes of abdominal distension?
Fat
Fluid
Fetus
Faeces
Flatus
Tumour
What should you do if someone has voluntary guarding on abdominal palpation?
Distract them and assess for involuntary guarding
What is Rovsing’s Sign?
Sign of appendicitis
Palpate the left side and pain is felt on the right: positive rosving’s
What is Murphy’s Sign?
Sign of acute cholecystitis
Palpate the right hypochondriac region during inspiration - if causes more pain: positive murphy’s
What are the benefits of a CT colon over a colonoscopy?
4 benefits
1 major drawback
Less severe bowel prep (as virtual colon)
Tolerated better by elderly and frail
Very low complication risk
Can be used where colonoscopy has failed to reach the caecum
If abnormal pathology is found - a colonoscopy may be need for biopsy/polyp removal
List 5 benefits/negatives of a flexible sigmoidoscopy vs colonoscopy
Bowel prep - just an enema for flexi, full bowel prep for colon
Perforation Risk - lower for flexi, higher for colon
View - limited for flexi to left side of bowel, stops at distal descending colon, vision until caecum for colon
Range of Symptoms - flexi good for just rectal bleeding symptoms, colon good for PR bleed, CBH, unexplained iron deficient anaemia
Polyps/lesions - if found by flexi, a colon will be needed anyway
What are the important planes to be aware of when examining the abdomen?
Mid-clavicular lines
Transpyloric plane (Bottom of ribs above epigastric region)
Subcostal plane (between epigastric and umbilical)
Transtubercular line (between umbilical and hypogastric)
What is the difference between biliary colic and bowel colic?
Biliary colic resolves between waves
Bowel colic does not
What is the key difference between areas affected by Chron’s and ulcerative colitis?
Chron’s : mouth to anus
Ulcerative Colitis: bowel and rectum only
What are some signs of oesophageal cancer?
Dysphagia
Weight Loss
Chest Pain (referred)
Decreased appetite
Vomiting
What lymph node is relevant for GI conditions?
Subclavicular
What would involuntary abdominal guarding be a sign of?
Peritonitis
When assessing a patient - what should you ask first and where should you start?
Ask about pain
Start away from pain
Where should you listen when auscultating for bowel sounds?
Right umbilicus
How often should you hear bowel sounds and how long should you listen for?
5-10 seconds
Up to 2 minutes
What is a positive Murphy’s sign for?
Cholecystitis : inflammation of gall bladder
