GI

Question 1

What quadrant of abdomen do gallstones usually cause pain in

Answer 1

Right upper quadrant
Radiates to shoulder tip
May also have diaphragmatic irritation

Question 2

After eating what kinds of foods might patients feel more pain if they have gallstones

Answer 2

After eating fatty foods

Question 3

Is pain associated with gallstones continuous or episodic

Answer 3

Episodic

Question 4

What causes gallstones

Answer 4

Gallstones occur when bile forms solid particles (stones) in the gallbladder. The stones form when the amount of cholesterol or bilirubin in the bile is high.

Question 5

Where does pain caused by appendicitis begin and where does it move to

Answer 5

In the middle of the abdomen - within a few hours moves into the right iliac fossa

Question 6

In pancreatitis, where does pain usually present

Answer 6

Epigastrium
/ centre of abdomen
Radiates through to back

Question 7

Onset of renal colic pain

Answer 7

Sudden onset of flank pain

Question 8

What is flank pain

Answer 8

Discomfort in your upper abdomen or back and sides - develops in the area below the ribs and above the pelvis

Question 9

Where does renal colic pain radiate to

Answer 9

Lateral abdomen or groin

Question 10

What is renal colic

Answer 10

Urinary stones block part of your urinary tract. Your urinary tract includes your kidneys, ureters, bladder, and urethra.

Question 11

What might relieve pain in patients with gallstones

Answer 11

Moving positions - certain forward or lying positions

Question 12

‘Pain in right abdomen near rib cage
Pain occurred during the night
Had to lean over the sofa to relive the pain’

What might this be caused by

Answer 12

Gallstones

Question 13

What associated symptoms should you ask about in GI history

Answer 13

• problems with mouth? - teeth, tongue, ulcers
• problems swallowing - dysphagia
• pain on swallowing - odynophagia, whereabouts, how severe
• indigestion, heartburn
• bloating, distension
• change in weight
• bowel habits: change, colour, consistency, frequency -what is normal for them
• faecal incontinence
  — could ask about fevers, night sweats

Question 14

If someone presents with has dysphagia what more could you ask?

Answer 14

What types of foods do you have problem swallowing? Eg, solids or softer foods?
How severe it is?

Question 15

What to ask further if someone has bloating?

Answer 15

When does this happen?

After eating particular foods?

Question 16

If a patient has both dysphagia to solids and odynphagia, what cause of dysphagia is this consistent with

Answer 16

Obstructive cause - eg, oesophageal cancer

Question 17

If a patient has dysphagia to liquids or coughing after swallowing liquids what body system would you be more likely to explore.

Answer 17

Neurological causes such as a stroke

Question 18

What does Malaena look like

Answer 18

‘Tarry’ black stool

Question 19

What is malaena a sign of

Answer 19

Blood loss from GI tract -

blood has gone through GI tract so by the time it reaches the bowel motion it has been altered by enzymes so stool looks black and tarry.

Question 20

What does only malaena indicate about amount of blood loss from GI tract

Answer 20

Probably small amount - large volume of blood loss would most likely present with haemotemasis as well as a degree of malaena.

Question 21

What does fresh blood in stool indicate about location of blood

Answer 21

More likely to be coming from colon
Eg, diverticular disease, bowel cancer?

(Or might be very brisk from upper GI so still appears to be fresh blood)

Question 22

Give 5 examples of GI diseases that can cause upper GI disease

Answer 22

Peptic ulcer
Gastritis 
Varices 
Mallory Weiss tear 
Oesophgeal or stomach cancer

Question 23

What to ask about in past medical history regarding GI

Answer 23

Alcohol intake? - eg, known alcoholic cirrhosis and varices?
Previous bleeding - any previous peptic ulcers
Any previous GI surgeries
Previous bowel problems
Drug history including allergies - over the counter and prescribed
Smoking history - eg, could related to IBD
Cardiac history? - eg, angina could be mistaken for indigestion

Question 24

If a GI bleed presents with no other symptoms what might be a likely diagnosis

Answer 24

Varices

Question 25

If a GI bleed also presents with bleeding what may be the possible diagnoses

Answer 25

Mallory Weiss tear

Peptic ulcer disease

Question 26

If a GI bleed also presents with weight loss, what could the causes possibly be

Answer 26

Peptic ulcer disease

Gastritis/ oesophagitis

Question 27

What signs and symptoms may you look for in the hands in a GI examination if someone presents with blood loss

Answer 27

Clinical signs of anaemia:
Leukonikia - pale nail
Choilonikia - nail looks ‘scooped out’
angular stomatitis -