GI Differentials

Question 1

young, periumbilical pain, r: RIF, anorexia

Answer 1

Appendicitis

Question 2

intermittent RUQ severe pain, exacerbated by fatty food, TIMING: constant, long episodes, random
No fever, normal inflamm markers

Answer 2

gallstones –> biliary colic

Question 3

continuous RUQ pain, fever, murphys sign OE, occasional deranged LFTs, fever

Answer 3

gallstones –> cholecystitis

Question 4

jaundice, fever/rigors, RUQ pain

Answer 4

gallstones –> cholangitis

Question 5

severe epigastric/central pain, radiating to back, relieved by sitting forwards, vomiting

Answer 5

pancreatitis

Question 6

epigastric pain- dull buring, rel to meals, rf: NSAIDS, alcohol, spicy foods, alleviated: foods, antacids, TIMING: night, episodes, waking

Answer 6

gastritis/ peptic ulcer

Question 7

elderly, LIF pain, pyrexia, diarrhoea (sometimes bloody), fever, raised inflamm markers, raised white cells

Answer 7

diverticulitis

Question 8

vomiting, abdo periumbilical colicky pain, no bowel motions/ constipation, frequent pain (ask for timing to determine intestine location)

Answer 8

bowel obstruction

Question 9

spasms of loin to groin excruciating pain, n & v, can’t lie still

Answer 9

renal colic

Question 10

increasing iliac fossa/ pelvic pain, 6wks preg/ not using contraception, may have spotting

Answer 10

ectopic

Question 11

change in bowel habit

Answer 11

Timing: start, acute onset/gradual, duration, progression, intermittent or continuous
Stool: how much, how often, consistency, colour, contents (mucus, blood)
What’s their normal bowel habit . Use bristol stool chart

Question 12

elderly, blood in stool/ melena, weight losss

Answer 12

colon cancer

Question 13

acute diarrhoea, n & v

Answer 13

gastroenteritis

Question 14

blood/mucus in stool, abd pain

Answer 14

inflamm bowel disease

Question 15

fluctuate between diarr & constipation, stress associated, anxious personality

Answer 15

irritable bowel syndrome

Question 16

diarrhoea, stetatorrhoea, anemia s&s, abd discomfort

Answer 16

coeliac disease

Question 17

diarrhoea, heat intolerance, irritability/restlessness, tremor, oligomenorrhoea/amenorrhoea

Answer 17

thyrotoxicosis

Question 18

constipation, cold intolerance, lethargy/tiredness, menorrhagia

Answer 18

hypothyroidism

Question 19

rectal bleeding

Answer 19

timing: when started, actue/gradual onset, duration, progression, intermittent/ continuous
Blood: fresh/altered/melaena, when does it occur
Stool: mucus - how much, how often, consistency

Question 20

bleeding when pooing, red on paper, intense anal pain, constipation hx

Answer 20

anal fissure

Question 21

haemorrhoids

Answer 21

bleeding on defecation, red on tissue, constipation hx

Question 22

distal polyp/ cancer

Answer 22

alternating bowel habit, weight loss, urgency, melena

Question 23

blood mixed in stool, mucus, diarrhoea, abd pain

Answer 23

inflamm bowel disease

Question 24

gastritis symptoms, rf: NSAIDS, alcohol, spicy food, melena

Answer 24

haemorrhagic/peptic ulcer/gastritis

Question 25

hx liver disease/alcholism, haematemesis, melena

Answer 25

oesophageal varicies

Question 26

Haematemesis

Answer 26

Timing: when started, actue/ gradual onset, duration, progression, intermittent or continuous
VOMIT: how much, how often, consistency, color & contents (mucus, blood, bile)

Question 27

abdominal pain

Answer 27

SOCRATES

Rel to meals, meds, vomiting, rel to pooing, farting,

Question 28

Diarrhoea

Answer 28

acute/ chronic, description - watery, pus, blood, fat, associating with meals, travel hx, change in diet

Question 29

n & v

Answer 29

cough vs vomit, ass headaches, timing - day or meal or early morn, acute vs chronic, appearance - bile, old food, blood, weight changes

Question 30

Jaundice

Answer 30

dark urine, pale stools, itchy, n & v, weight loss, loss of appetite, shx- alcohol, IV, sex high risk, hep b vacc

Question 31

dysphagia

Answer 31

liquids vs solids, associated pain. difficulty initiating, food sticking site, ass heartburn, progressive severity, onset, duration, progression, severity, alleviating f, regurgitation, hoarse voice, otalgia, cough after eat, frequent chest infections

Question 32

painless jaundice, steatorrhea

Answer 32

pancreatic cancer

Question 33

65 yo woman, jaundice, weight loss, clay colored stools, recurrent episodes of colicky RUQ pain. O/E palpable mass in RUQ

Answer 33

cholangiocarcinoma

Question 34

prodromal illness and right upper quadrant pain
Swinging pyrexia
Patient may be systemically unwell
Generalised peritonism not present

Answer 34

gallbladder abscess

Question 35

Diarrhoea usually non-bloody
Weight loss more prominent
Upper gastrointestinal symptoms, mouth ulcers, perianal disease
Abdominal mass palpable in the right iliac fossa

Answer 35

Crohns

Question 36

Bloody diarrhoea more common
Abdominal pain in the left lower quadrant
Tenesmus

Answer 36

UC

Question 37

early: may be asymptomatic (e.g. raised ALP on routine LFTs) or fatigue, pruritus
cholestatic jaundice
hyperpigmentation, especially over pressure points
around 10% of patients have right upper quadrant pain
xanthelasmas, xanthomata
also: clubbing, hepatosplenomegaly
late: may progress to liver failure

Answer 37

primary biliary cholangitis