GI

Question 1

What are the causes of hepatomegaly?

Answer 1

Hepatitis, hepatocellular carcinoma, hepatic metastases, Wilson’s disease, haemochromatosis, leukaemia, myeloma, glandular fever, primary biliary cirrhosis, tricuspid regurgitation and haemolytic anaemia

Question 2

What does the age of a patient mean in terms of a GI symptoms when completing an abdo examination?

Answer 2

1. Younger patients more likely to be conditions such as IBD.
2. Older patients more likely to be liver disease or malignancy.

Question 3

What is confusion a sign of in terms of patients with GI conditions?

Answer 3

It can be a sign and feature of end stage liver disease, known as hepatic encephalopathy.

Question 4

What can abdominal distention be a sign of in terms of GI conditions?

Answer 4

Presence of ascites or underlying obstruction and/or organomegaly.

Question 5

What can underlying anaemia be a sign of in terms of GI conditions?

Answer 5

GI bleeding or malnutrition and patient presents with with pale looking skin.

Question 6

What is jaundice a sign of in terms of GI conditions?

Answer 6

Acute hepatitis, liver cirrhosis, cholangitis, pancreatic cancer.

Question 7

What is hyperpigmentation?

Answer 7

Bronzing of the skin associated with haemochromatosis

Question 8

What is cachexia associated with?

Answer 8

Commonly associated with underlying malignancy and advanced liver failure.

Question 9

What is cachexia?

Answer 9

Ongoing muscle loss that is not entirely reversed with nutritional supplementation.

Question 10

What can palmar erythema be a sign of?

Answer 10

Chronic liver disease. Also a normal finding in pregnancy due to increased oestrogen levels.

Question 11

What is duputren’s contracture a sign of?

Answer 11

Liver disease, excessive alcohol use, increase in age, males or diabetics.

Question 12

What are Koilonychia and what can they be a sign of?

Answer 12

Spoon shaped nails Associated with iron deficiency anaemia such as malabsorption in Chron’s disease

Question 13

What is leukonychia and what is this a sign of?

Answer 13

Whitening of the nail bed associated with hypoalbuminaemia

Associated with end stage liver disease, protein losing eteropathy, chemo

Question 14

What are the abdominal causes of finger clubbing?

Answer 14

IBD, coeliac disease, liver cirrhosis and lymphoma of the GI tract.

Question 15

What is asterixis and what is it a sign of in terms of abdo?

Answer 15

This is a flapping tremor and can indicate an underlying cause of hepatic encephalopathy or uraemia secondary to renal failure.
CO2 retention secondary to type 2 resp failure is another cause.

Question 16

What are excoriations and what can they indicate?

Answer 16

Scratch marks that may be caused by patients trying to relieve pruritis and in terms of abdo examination, this can suggest underlying cholestasis.

Question 17

What is acanthosis nigricans and what does it indicate?

Answer 17

This is darkening and thickening of the axillary skin which can be benign or associated with insulin resistance or GI malignancy.

Question 18

What is corneal arcus and what does it show?

Answer 18

A hazy white, grey or blue opaque ring located in the peripheral cornea, typically occuring in patients over the age of 60.
It can be benign in the over 60’s but in younger patient under 50 can suggest hypercholesterolaemia.

Question 19

What is angular stomatitis and what does it show?

Answer 19

This is a common inflammatory condition affecting the corners of the mouth.
Wide ranges of causes including iron deficiency (GI malignancy, malabsorption, poor oral hygiene)

Question 20

What is glossitis and what does it show?

Answer 20

It’s a smooth erythematous enlargement of the tongue associated with B12 and folate deficiency.
It can indicate malabsorption secondary to inflammatory bowel disease.

Question 21

What does enlargement of the left supraclavicular lymph node mean?

Answer 21

Enlargement of the Virchow’s node can be the first indication of metastatic intrabdominal malignancy (Most commonly gastric cancer)

Question 22

What causes spider naevi and how many can indicate liver cirrhosis?

Answer 22

Caused by elevation of circulation oestrogen levels. They can be raised in pregnancy or in women taking the OCP. Allow up to 3. 5 or more are indicative of liver cirrhosis.

Question 23

What is gynaecomastia and what does it indicate?

Answer 23

This is an enlargement of male breast tissue caused by increased circulation oestrogen levels through liver cirrhosis. It can also be caused by digoxin and spironolactone.

Question 24

What are the six F’s?

Answer 24

Fat, fluid, flatus, faeces, fetus or fulminant mass

Question 25

What is Cullen’s sign?

Answer 25

Bruising around the umbilicus that can indicate haemorrhagic pancreatitis.

Question 26

What is Grey - Turner’s sign?

Answer 26

Bruising in the flanks associated with late sign haemorrhagic pancreatitis.

Question 27

What is rebound tenderness?

Answer 27

This is present when the abdo wall, having been slowly compressed is released rapidly and results in a sudden sharp abdo pain. It is non specific but can indicate peritonitis.

Question 28

What is Rovsing’s sign?

Answer 28

Palpation of the left illiac fossa causing pain to be experienced in the right iliac fossa.
This indicates peritonitis

Question 29

What is Murphy’s sign?

Answer 29

Used to indicate cholecystitis

Ask the patient to breath in whilst pressing on the area and see if they stop half way.

Question 30

What are causes of splenomegaly?

Answer 30

Include:

• Portal hypertension secondary to liver cirrhosis
• Haemolytic anaemia
• Congestive heart failure
• Splenic metastases
• Glandular fever

Question 31

What can assessing shifting dullness be used for?

Answer 31

Used to assess the presence of ascites.

Question 32

What can tinkling bowel sounds indicate?

Answer 32

Associated with bowel obstruction.

Question 33

What can absent bowel sounds indicate?

Answer 33

Typically suggests ileus which is a disruption of the normal propulsive ability of the intestine due to a malfunction of peristalsis.