GI Clinical Signs

Question 1

Pain initial in the central abdomen before localising to the right iliac fossa (RIF).
Anorexia is common.
Tachycardia.
Low-grade pyrexia.
Tenderness in RIF
Rovsing’s sign: more pain in RIF than LIF when palpating LIF

Answer 1

Appendicitis

Question 2

Colicky pain typically in the LLQ
Diarrhoea, sometimes bloody
Fever, raised inflammatory markers and white cells

Answer 2

Acute diverticulitis

Question 3

History of malignancy (intraluminal obstruction)/previous operations (adhesions)/Crohns
Vomiting. Not opened bowels recently
Tinkling bowel sounds

Answer 3

Intestinal obstruction

Question 4

RUQ pain

Caused by a gallstone getting lodged in the bile duct
Classically provoked by eating a fatty meal
No fever and inflammatory markers are normal

Answer 4

Biliary colic

Question 5

RUQ pain
Inflammation infection of the gallbladder secondary to impacted gallstones
Murphy’s sign positive (arrest of inspiration on palpation of the RUQ)
Fever and raised inflammatory markers

Answer 5

Acute cholecystitis

Question 6

Charcot’s triad of right upper quadrant pain, fever and jaundice occurs in about 20-50% of patients

Answer 6

Ascending cholangitis

Question 7

Epigastric pain - sometimes radiating through to the back
Usually due to alcohol or gallstones
Pain is often very severe.
Examination may reveal tenderness, lies and low-grade fever

Answer 7

Acute pancreatitis

Question 8

Pain relieved by eating

Answer 8

Duodenal ulcer

Question 9

Pain worsened by eating

Answer 9

Gastric ulcers