GI Flashcards
leukonychia: what is it and GI causes
whitening of nail bed
hypoalbuminaemia –> liver disease
koilonychia: what is it and GI causes
spoon nails
anaemia
GI causes of finger clubbing
liver cirrhosis
IBD
coeliac
GI cause of asterixis (flapping tremor)
hepatic encephalopathy
GI cause palmar erythema
chronic liver disease
cause of duputren’s contracture
alcohol
GI cause bruising
clotting abnormalities caused by liver dysfunction
GI cause scratch marks
chronic cholestasis
what is parotid swelling caused by
alcohol
what do look for in eyes of GI examination
jaundice
conjuncival pallor –> anaemia
what do look for in mouth when GI examination
angular stomatitis (Fe def anaemia) odur of foetor hepaticus)
where is Virchow’s node
left supraclavicular fossa
what do we look for on chest during GI examination
spider naevii
gyncaecomastia
hair loss
leg signs during GI examination
peripheral oedema - hypoalbuminaemia (liver failure)
hair loss
erythema nodosum - IBD
9 regions abdomen
R + L hypochondriac epigastric R + L lumbar umbillical R + L inguinal hypogastric
what looks for when inspecting abdomen
scars adbominal distension caput medusae striae movement with respiration stoma petechiae visible pulsation
causes of abdominal distension
fat flatus faeces fluid foetus
what are caput medusae a sign of
portal hypertension
what do we look for during light palpation of abdomen
tenderness rebound tenderness involuntary guarding Rovsing's sign masses
what is rebound tenderness a sign of
peritonitis e.g. appendicitis
what is rovsing’s sign and what does it suggest
palpation of left iliac fossa causes pain in right iliac fossa
peritonitis
what may be felt normally during deep palpation of abdomen
pulsation of abdo aorta
caecum (R. iliac)
desc. and sigmoid colon (L)
what do we need to talk about when describing a mass felt
location: which region of abdomen
approx size and shape
consistency: smooth, soft, hard, irregular
mobility: is it attached to surrounding structures
does it pulse
when palpating liver what do need to talk about
is it palpable?
degree extension below costal margin (>2cm hepatomegaly)
consistency (nodular = cirrhosis)
tender (if so then hepatitis, cholecystitis)
is it pulsatile (tricuspid regurgitation)
causes of hepatomegaly
hepatitis hepatocellular carcinoma haemachromatosis leukaemia myleoma haemolytic anaemia tricuspid regurgitation glandular fever
causes of splenomegaly
congestive heart failure
haemolytic anaemia
portal HTN 2nd to cirrhosis
splenic metastases
can kidneys be palpated
occasionally in very slim person may feel lower pole of R kidney
causes of enlarged kidneys
polycystic kidney disease
renal tumour
amyloidosis
tinkling bowel sound
bowel obstruction
absent bowel sounda
> 2min listenign
paralytic ileus
abominal aorta bruit
atheroma
aneurysm
renal artery bruit
renal artery stenosis
liver bruit
hepatocellular cancer
splenic bruit
A-V fistula
hepatic rub
splenic rub
rub indicated inflammation of capsule surrounding organ
GI systemic enquiry
appetite/weight loss or change mouth/teeth/tongue dysphagia dyspepsia/heartburn nausea/vomitting haematemesis fat intolerance jaundice abdominal distension + bloating abdominal pain bowel habit (change, constipation, diarrhoea, blood, mucus, meleana, faecal incontinence) perinanal symptoms - pain, itching
jaundice: what is it and
GI causes of it
yellowing skin/sclera + dark urine
hepatitis, liver cirrrhosis and biliary obstruction (gallstone, pancreatic Ca)
vomiting: GI causes of it
gastroenteriris GORD pyloric stenosis bowel obstruction gastropareis
haematemesis: what is it and
GI causes of it
vomitting of blood
bright red: oesophageal varices rupture
coffee ground: gastric/duodenal ulcer
dysphagia: what is it and
GI causes of it
difficulty swallowing
oesophageal cancer
abdominal distension: GI causes
ascites
constipation
bowel obstruction
malignancy
constipation: GI causes
dehydration
reduced bowel motility
medications e.g. opiates, Fe supplements
diarrhoea: GI causes
infection e.g. C.diff IBS IBD medication e.g. laxative constipation with overflow malignancy
steatorrhoea: what is it and
GI causes of it
excess fat in faeces causing them to appear pale and be difficult to flush
pancreatitis, pancreatic Ca, biliary obstruction, coeliac
melaena: what is it and
GI causes of it
dark, tar-like stooks containing digested blood
upper GI bleeding - peptic ulcer
causes of R. iliac fossa pain
appendicitis
Crohn’s
causes of L. iliac fossa pain
diverticulitis
causes of epigastric pain
oesophagitis
gastritis
causes of R upper quadrant pain
cholecystitis
hepatitis
causes of flank pain
renal colic
pyelonephritis
causes of suprapubic pain
UTI
GI risk factors
pre-existing GI disease e.g. GORD, crohn's Fx GI disease alcohol (alcoholic hepatitis/cirrhosis) smoking (GI cancers, crohn's) rec. drugs (hepatitis) diet (coeliac)
during DRE what to look for during inspection of perianal area
skin excoriation
anal fissure
external bleeding
anal fistula
ask pt to bear down
- haemarrhoids
- rectal prolapse
assessing anal tone during DRE
and cause of reduced anal tone
with finger inserted ask them to bear down
IBD, prev rectal surgery, spinal cord pathology e.g. cauda equina syndrome
assessing postelateral walls during DRE
sweep finger to right (upwards) for right posterolateral quadrant
sweep to left (downwards) for left posterolateral quadrant
what can be palpated through anterior wall DRE
men: prostate
women: cervix/tampon
what needs to be noted when examining rectal walls
presence/abscence of stools and consistency (e.g. hard = consipation)
ireegularities/masses
areas of tenderness
when bear down again if a lesion is brought down from higher up
what do we inspect finger for once its withdrawn
stool
blood mucous
blood on finger after DRE
meleana: upper GI bleed e.g. gastric ulcer
bright red: lower GI bleed e.g. rectal malignancy, fissure
excess mucous on finger after DRE
IBD e.g. ulcerative colitis
