GI Flashcards
What are you looking for in the hands?
Clubbing, leuconychia, koilonychia, duputrens contracture, spider naevi, hepatic flap, palmar erythema
What is leuconychia? What is it caused by?
Leuconychia is whitening of the nail
Leuchonychia partialis is benign and only a small area of nail is whitened
Leuconychia totalis is total whitening of the nail and may be indicative of hypoalbuminaema
What is koilonychia? What is it caused by?
Spooning of the nails
caused by iron deficiency anaemia, folate or b12 deficiency
What are spider naevi? What causes them? How many would indicate an anormality?
spider naevi are small red dots with red lines projecting out of them like a spiders web
Caused by high levels of circulating estrogens which dilate arterioles. High levels of estrogens can be due to liver failure and cirrhosis as they are not broken down
More than 2 - abnormality
What is dupuytrens contracture?
Abnormal thickening of fascia in hand changing from collagen type 1 to type 3
What is palmar erythema? What causes it?
Reddening of the palms
Caused by portal hypertension and chronic liver disease
What do you look for in the face?
Jaundice, mouth ulcers, tongue disorders, dehydration of tongue
Why do you look for mouth ulcers in a GI exam?
Indicates crohns disease or coeliac disease
What is cullens sign?
bruising surrounding umbilicus due to retroperitoneal bleeding
What is grey-turners sign?
Bruising around the flanks due to retroperitoneal bleed
What does rebound tenderness indicate?
Peritonitis
What is shifting dullness testing for? What is it?
Ascites
percuss and if dull, get them to lie on their side and percuss again in the same place
What are liver bruits?
Turbulent flow in an artery of the liver
How would you complete the examination?
Inspect hernial orifices, external genitalia, DRE, temperature, and urinalysis
What can abdominal distension be due to?
6 F’s
Fat, Fluid, Fetus, Flatus, Faeces, Filthy big tumour
What could cause hepatomegaly?
Metastases, fatty liver, alcoholic liver disease, right heart failure, hepatitis
What could cause splenomegaly?
malaria, portal hypertension, thalassema, haemolytic anemia, infection
What are normal bowel sounds? What could it be increased or decreased by?
Gurgling every 10-20 seconds
increased - IBS, gastroenteritis
Decreased - surgery, paralytic ileus
What is a direct and indirect inguinal hernia? Which sex is it more common in?
More common in males due to descent of testes
Direct - through hasselbachs triangle
Indirect - Through deep and superficial inguinal ring
femoral hernia- which sex is it more common in?
More common in females
What spinal level is the kidneys at?
Right - T12 to L3
Left - T11 to L2
How would you treat a H Pylori infection?
Clarithromycin and amoxicillin and H2 antagonist or PPI
Stop NSAIDs
What are biomarkers of pancreatic diseae?
Pancreatic amylase, decreased calcium, increased ALP, hyperglycaemia
What LFTs are used?
ALT/AST
INR
Albumin
Bilirubin
Gamma-GT
What would tests reveal in prehepatic jaundice?
Decreased haptoglobin, hyperbilirubinemia, Increased LDH
What would tests reveal in hepatic jaundice
Increased ALT and AST, Increased INR, hyperbilirubinemia
What would tests reveal in post hepatic jaundice
Dark urine due to bilirubin, pale stool
How would you differentiate between crohns and UC?
UC - continuous rectal involvement results in gross bleeding and mucosal friability
Crohns thin friends fuck sexy customers - Transmucosal inflammation, fissures, fibrosis/fistulas, submucosal inflammation, cobblestoning
What gram negative and positive bacteria usually cause a UTI
negative - e coli
Positive - enterococcus
How would you treat a UTI complicated and uncomplicatd?
Complicated - 5 day course Trimethoprim or nitrofurantoin
Uncomplicated - 3 day course Trimethoprim
How would you treat pyelonephritis?
Co-amoxiclav 14 day course
What is nephrotic and nephritic syndrome?>
Nephrotic - Proteinuria (>5g/24hr), hyperlipidemia
Nephritic - Haematuria, midl hypertension, oligouria, small proteinuria
Give examples of nephritic syndrome disease
VAIG nephritic syndrome
Vasculitis, Alport syndrome, IgA nephropathy, Goodpasture syndromes
Give examples of nephrotic syndrome disease
Primary - Minimal change glomerulonephritis, minimal change focal segmental glomerulosclerosis, membranous glomerulonephritis
Secondary - SLE, amyloidosis, DM
What would CKD lead to?
EPO anaemia, osteodystrophy (due to vit D hydroxylation in kidneys)
