GI & abdominal examination

Question 1

List the 9 common symptoms of GI diseases

Answer 1

Nausea
Dysphagia
Vomiting
Heartburn/Indigestion
Abdominal pain
Abdominal swelling
Weight loss
Jaundice
Disturbed bowel habit (constipation, diarrhoea)

Question 2

Name three filling (irritative) symptoms of the lowe urinary tract

Answer 2

frequency, urgency, nocturia, dysuria

Question 3

Name four voiding (obstructive) symptoms of the lower urinary tract

Answer 3

poor stream

hesitancy

terminal dribbling

incomplete voiding

overflow incontinence

Question 4

Name six systemic features of inflammatory bowel disease

Answer 4

General: Fever, malaise, weight loss

Eyes: Conjunctivitis, episcleritis,

Joints: arthralgia of large joints, anylosing spondilitis

Skin: Mouth ulcers, erythema nodosum

Liver: Fatty liver, gall stones,

Question 5

Name 7 signs of chronic liver disease

Answer 5

Finger clubbing

Leukonychia

Palmer erythema

Dupuytren’s contracture

Spider naevi

Gynaecomastia

Peripheral oedema

Parotid enlargement

Loss of axillary hair

Question 6

What is guarding?

Answer 6

reflex contraction of the abdominal muscles on light palpation. Associated with localised pain due to inflammation of the parietal peritoneum

Question 7

What is rebound?

Answer 7

Pain caused by the sudden withdrawl of a firmly applied hand on the abdominal wall. Suggests the presence of an underlying inflamed organ.

Question 8

Why would you see visible peristalsis in a patient?

Answer 8

In cases of pyloric stenosis, dilated obstructed stomach forms a prominent swelling in the upper abdomen

Question 9

What is asterixis?

Answer 9

Flapping tremous seen in hepatic encephalopathy. When arms are stretched out, patient’s cannot keep wrists extended for 15-30 seconds, flapping of the hands visible

Question 10

List 3 possible causes of hepatomegaly

Answer 10

Viral hepatitis

cirrhosis

congestive heart failure

alcholic hepatitis

hepatocellular cancer

hepatic metastasis

Question 11

List 3 possible causes of splengomegaly

Answer 11

portal hypertension

haemolytic anaemia

infection

Question 12

Name two diseases which cause both hepatomegaly and splengomegaly

Answer 12

lymphoma

cirrhosis

sarcoidosis

amyloidosis

myelofibrosis

Question 13

Name the 5 causes of abdominal distension

Answer 13

Flatus

Faeces

Fluid

Foetus

Flipping big mass (tumour)

Question 14

Explain the mechanism of Murphy’s sign

Answer 14

Murphy’s sign is elicited on palpating at the costal margin of the right upper quadrant.

The patient is instructed to exhale and a hand is placed on the costal margin.

On inspiration as the diaphragm pushes down the liver and gall bladder move with it. If the gall bladder is inflamed then the patient will experience a sharp pain as the gall bladder contacts the palpating hand and stop mid-inhalation.

Question 15

List 15 clinical signs present in patients with Chronic liver disease

Answer 15

Classic signs: oedema Muscle wasting Leukonychia Clubbing Jaundice Portal hypertension: Caput’s medusa As cites Splenomegaly Oestrogen excess: Gynacomastia Testicular atrophy Loss of body hair Palmar erythema Spider naevi Others: Duputyren’s contracture Parotid enlargement

Question 16

List three causes of obstructive jaundice

Answer 16

Obstruction of the common bile duct

Cancer (bile duct or head of the pancreas)

Biliary stricture

Question 17

List 3 possible causes for dysphagia

Answer 17

1. Intrinsic lesion (tumour, stricture)
2. Extrinsic pressure (enlarged thyroid, aortic aneurysm, bronchial cancer)
3. Motility disorder (aperistalsis or neurological disorder)

Question 18

Blood in the stools (3 types of presentation)

Answer 18

Black, tar-like: Meleana. Indicative of an upper GI bleed. Blood is then modified by the activity of intestinal bacteria as it passes through the bowel. Continuous, profuse bleeding. Dark red: blood is unchanged, therefore lower GI bleed. Profuse bleeding indicative of rupture e.g. Diverticular disease Intermittent bright bed blood: bleeding in the rectum or anal canal, likely due to polyps or haemorrhoids

Question 19

Grey turner’s sign

Answer 19

Bruising of the flanks associated with retroperitoneal haemorrhage. Sign of acute pancreatitis

Question 20

How would you examine a patient for ascites?

Answer 20

Percuss for ‘shifting dullness’

Percuss from the umbilicus down the right side of the abdomen, if an area of dullness is detected keep two fingers on it and ask the patient to roll to the left.

Percuss again from the lower side after 30 seconds. If ascites is present, dullness will have shifted upwarsd due to the redistribution of fluid.

Question 21

Causes of hypoactive bowel sounds

Answer 21

Constipation

General anathesia

Abdominal surgery

Paralytic ileus

Anticholinergics/opiates

Question 22

Causes of hyperactive bowel sounds

Answer 22

Diarrhoea

Inflammatory bowel disease

GI bleeding

Mechanical bowel obstruction

Question 23

Abdominal causes of clubbing

Answer 23

Hepatic cirrhosis

Chrons disease

Coeliacs disease

Ulcerative colitis

Question 24

Blood investigations in patients with IBD

Answer 24

FBC - anaemia

CRP, ESR - inflammation

Albumin - malnutrition

Question 25

Drugs used in treatment of IBD

Answer 25

Steroids: Imunnosuppressant

Aminosalicylates: long term prevention of remission

DMDs: maintains remission long term

mAbs

Question 26

Use of steroids in IBD

Answer 26

Glucocorticoids inhibit synthesis of pro-inflammatory cytokines.

Used for short periods to induce remission. Long term treatment causes side effects (e.g. osteoporosis, muscle wasting, diabetogenic, water retention)

Question 27

Immunomodulators used in IBD

Answer 27

Azathioprine: Antimetabolite for purines in nucleic acid synthesis. Modify lymphocyte function.

Methotraxate: Folic acid antagonist

Cyclosporin: IL2R inhibitor. Inhibits B-cell activation

Cause bone marrow suppression, nausea, vomiting