GI

Question 1

Localisation of pain

Answer 1

Foregut epigastric
Midgut peri umbilical
Hindgut suprapubic

Other
Diaphragm rt shoulder
Gallbladder tip scap LUQ
renal ureter groin crease inner thigh 
Torsion also pain

Unpaired to back/midline ie panc
Paired to that side

Question 2

Dysphagia

Answer 2

Neuro liquids worse
Neuromuscular dysmotility solids worse

Pouch regurgitation
Mech food sticking

Question 3

Distention

Answer 3

Fat
Flatus obstruction
Faeces or constipation 
Fluid ascites
Foetus
Functional

Question 4

Jaundice

Answer 4

Increased bilirubin production ie haemolysis

Decreased excretion
Unconjugated if Gilbert’s syndrome

Hepatocellular ie viral hep, cirrhosis, drugs
Intrahepatic PBC, drugs

Extra hepatitic OBSTRUCTIVE gallstones, panc ca, cholangioca
IE pale stools no urobilinogen

Question 5

History

Answer 5

PHMx
Meds ie gi effects
FHx IBD, ca, herred ie Gilbert’s AD, haemochromatosis AR

Risk factors

Question 6

Bedside

Answer 6

Nutritional - height weight BMI waist circ

Question 7

Hands

Answer 7

Asterixis ie hepatic encephalopathy

Clubbing - cirrhosis, IBD, malabs
Leuconychia - low albumin
Koylonichia

Palmar erythema - liver disease or pregnancy
Dupytrens - etohxs

Needle tracks/tattoos
Reduced axillae hair

Question 8

Face

Answer 8

Mouth
Ulcers
Anaemia - angular chelatitis, atrophic glossitis B12 folate
Aphthous ulcers - coeliac
Breath ie f hepaticus = mousy dimethyl sulphide portosystemic shunt

EYES pallor and jaundice ie sclera

Etohxs or siderosis bilat parotid swelling

Cervical nodes ie mets

Question 9

Skin/veins

Answer 9

SPIDER NAEVI - chronic liver disease n 5-6 CHECK BACK TOO

Striae - cushings/preg/rapid growth
Bruising/scratches- liver failure
N older = haemangiomas/campbell de morgan spots

VEINS
caput medusae - distended draining away umbilicus ie PVH/liver = recanalisation of umbilical vein down falciform ligament
Umbilical varix - v hernia, distended blue
IVC obstruction - collaterals

Liver disease ie xs oestrogen
Spider naevi - SVC distribution, women 5 = normal
Gynaecomastia, loss body hair, testicular atrophy

LNs
Trosiers sign - left supraclav = gastric/pancreatic ca
Widespread = lymphoma

Question 10

Abdo shape

Answer 10

?shape
N symmetrical, mainly diaphragmatic resp

Diffuse swelling - ascites/obstruction
Local - u retention/mass/organomegally

Scars
RUQ loop colostomy
RIF ileostomy

LIF colostomy ie terminal

Question 11

Palpation

Answer 11

Tenderness - light palpation = flat of hands watching face, distant from tenderness

Peritonitis - invol guarding, rebound t, board like rigidity

Epigastric - PUD
RH - GB
LIF - diverticulitis
RIF - appendix/crohns ileitis

Question 12

Masses

Answer 12

Pulsatile/upper = AAA
Faeces
Umbilical hard LN = ca Sister Mary Joseph’s

Question 13

Organomegally

Answer 13

Hepatomegally - lat to rectus sheath, move up cms

Size
Surface
Consistency
Tender/pulsatile

GB - ? Tender ie RUQ mid clav
Palpable = rare

Splenomegally = start at u, hold up other side…length of costal margin, n= 9-11th
x3 size palpable
Enlarges medially to umbillicus ?notch
OR ROLL ON RT

THEN PERCUSS!

Kidneys ie ballot, renal angles

SACRAL OEDEMA!

Question 14

Splenomegally causes

Answer 14

Haem
Lymphoma/lymphatic ca
Myeloprolif

PVH
Rheum ie RA/SLE
Rare ie sarcoid

Question 15

Hepatomegally causes

Answer 15

Early cirrhosis
Fatty liver
Mets - hard irreg
TR PULSATILE
Cor pulmonale ie r hf soft/tender

Question 16

Percussion

Answer 16

Liver - hold deep insp ie n 5th IC to cm below costal margin
? Englarged or displaced down by hyperinflation

Ascites = shifting dullness ie percuss midline to flanks, roll, pause 10sec
Fluid thrill = one hand flat on side, flick with other ?transmission. PT HAND ON MIDLINE

Question 17

Causes of ascites

Answer 17

Transudate
Cirrhosis PVH
Hepatic vein occlusion - acute ie budd chairi malformation
Nephrotic

Exudate
Abdo malig + peritoneal spread

Low glucose
TB peritonitis

Question 18

Auscultation

Answer 18

R umbillicus 2mins
2-3cm above and lat ie renal bruits/RAS
Hepatic bruits ie hepatitis
Abovevie aaa
Succussion splash = rock pelvis delayed eg 4hrs + emptying ie pyeloric stenosis

Question 19

Bowel sounds

Answer 19

N gurgling 5-10 sec

Reduced
Paralytic illeus
Peritonitis

Increased/tinkling
Obstruction

Question 20

Hernias

Answer 20

Examine standing ie ing, fem, scrotum

Inspect
Cough impulse - palpate ext ring, cough
Femoral - below and lat to ing ring

Question 21

Others

Answer 21

LEGS
oedema - hypoalbuminaemia
Pyoderma gangrenosum IBD
Erythema nodosum - sarcoid, IBD, drugs, infections

PR/genital
Ix