GI Flashcards
A past history of relapsing epi gastric pain in a patient presenting with severe abdominal pain could suggest what ?
Perforation of long standing peptic ulcer
Recurrent mouth ulcers could be a sign of which GI diseases?
Crohn’s
Ulcerative colitis
How might a previous cholecystectomy result jaundice ?
The operation caused a biliary stricture
Describe the characteristic radiation of pancreatic pain
Pain radiating straight through to the back
Pain radiating loin to groin is characteristic of:
Renal colic
Where does the pain of oesophageal reflux radiate ?
Up the neck
Referred pain to the tip of the shoulder is due to what ?
Diaphragmatic irritation
Colicky pain results from what ?
Obstruction of a hollow viscus (bowel, ureter)
Is pancreatic pain usually steady or episodic ?
Steady
How might patients attempt to relieve colicky pain (positional)
Rolling around vigorousl
How is pancreatic pain characteristically relieved ? (Positionally)
Sitting and leaning forward
If abdominal pain is relieved by eating what might the cause be ?
Duodenal ulcer
Fatty foods precipitate pain from where ?
Gall bladder
A chronic erratic disturbance of defection associated with abdominal pain and bloating is characteristic of which condition ?
IBS
Differential diagnoses In a patient with recent diarrhoea or constipation associated with colicky pain, possible blood/mucous in stool
Large bowel malignancy
Stricture formation
Typical symptoms of rectal malignancy:
Increased frequency
Tenesmus
Classic presentation if gallstones
Jaundice associated with biliary pain
Progressive dysphagia, starting with solids and progressing to liquids has which likely causes?
Carcinoma
Stricture
Intermittent dysphagia with liquids and solids suggests which cause ?
Motility disorder e.g. Achalasia or diffuse oesophageal spasm
How can you differentiate between achalasia and diffuse oesophageal spasm?
If dysphagia eases after first few swallows it is oesophageal spasm
If the cause of dysphagia is in the pharynx e.g. A neurological disease such as MND, what is the characteristic symptom ?
Fluid regurgitation into throat and nose
What is troisier’s sign ?
Virchows node in the supraclavicular area indicating possible carcinoma of the stomach or oesophagus
What food and drinks commonly aggravate reflux symptoms ?
Alcohol, chocolate, caffeine and fatty meals
What postural changes are known to aggravate GOR ?
Bending, stooping or lying down
Differential diagnoses for early morning vomiting ? (Name 3)
- Pregnancy
- Alcoholism
- Raised ICP
Differential if vomiting is delayed by more than 1 hour after meal ?
- Gastric outlet obstruction
2. Gastroparesis
Differential diagnoses for a patient who has had a short history of jaundice with a prodromal illness ?
- Hepatitis
2. Gallstones
Itching that’s worse over the extremities is suggestive of what ?
Cholestatic liver disease
Which liver condition may lead to easily bleeding/bruising ?
Obstructive jaundice
( results in shortage of bile salts (which emulsify fats) in the intestine and therefore reduces vitamin k absorption (which is fat solvable)- which in turn decreases the Production of clotting factors 2, 7, 9 and 10)
Which type of diarrhoea persists when the patient fasts ? And what are its causes ?
Secretory diarrhoea - caused by infections or carcinoid syndrome
What type of diarrhoea is. Characterised by large volume stools related to the ingestion if food ? And what are its causes ?
Osmotic diarrhoea - caused by: lactose intolerance, magnesium antacids, or gastric surgery
The pain of Which GI conditions may be relieved by passing flatus or stool ?
IBS
Diverticulitis
What is the significance of commenting on rate and regularity of radial pulse in a GI exam ?
AF may throw off emboli into the mesenteric arteries leading to bowel Ischaemia with severe abdominal pain.
3 GI causes of Clubbing
- GI lymphoma
- IBS
- Coeliac disease
What does koilonychia indicate ?
Anaemia
What is leuconychia and what does it indicate ?
Opacification of the nail bed, may be due to hypoalbinaemia
Name a GI cause of palmar erythema
Chronic liver disease
Why do we look for Dupuytren’s contracture in a GI exam?
Can be a sign of alcoholism
May also be because of manual work or familial
What is an hepatic flap and when does it occur ?
Coarse irregular tremor when the arms are held outstretched with wrists dorsiflexed (15 secs)
- occurs in liver failure
Name the 3 things you look for in the eyes during a GI exam
- Signs if anaemia in the conjunctiva
- Jaundice in the sclera
- Kayser-Fleischer rings (as in Wilson’s disease which leads to cirrhosis)
Signs to look for in the mouth during GI exam ? (4)
- Angular stomatitis - iron and B12 deficiency
- Glossitis - B12/folate deficiency (painful) iron deficiency (painless)
- Circumoral pigmentation - peutz-jeugers syndrome - signifying small bowel polyposis
- Apthmous ulcers - IBS, coeliac (ulcers on the tongue may be malignant)
What are the 5 Fs describing the causes of a distended abdomen ?
- Fat
- Flatus
- Foetus
- Faeces
5 fluid
What condition is likely if the abdomen is still with respiration ?
Peritonitis
What causes caput medusae?
Portal hypertension
What doors presence of spider naevi on upper abdomen and chest suggest ?
Cirrhosis
If 5 or more present
What 4 questions are asked in the CAGE questionnaire ? (Alcohol history)
- Have you ever felt you should cut down on your drinking ?
- Have people ever annoyed you by criticising your drinking ?
- Have you ever felt bad/guilty about your drinking
- Have you ever had a drink when you wake up in the morning to steady your nerves/ get rid of hangover (eye opener)
