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OSCE 1 > GI Differentials > Flashcards

GI Differentials Flashcards

1
Q

What are the differentials to conside in haematemesis?

A
  • Oesophageal varicies
  • peptic ulcer
  • malignancy
  • bleeding disorderr
  • mallory-weiss tear
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2
Q

What are important things to consider in haematemesis?

A
  • ODP, Ass, ICE, PMHx, DHx, FMHx, SHx
    • had they just had a nosebleed?
    • ?BLOOD THINNERS- this is an option in any bleeding presentation
  • any acute bleeding - ABCDE approach
  • cross match in case of further haemorrhage
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3
Q

In a haematemesis history, what will examination/hx finding show if there are oesophageal varicies?

What Ix should be done?

A

PMHx - liver cirrhosis, portal hypertension

SHx - heavy alcohol consumption

Ass q’s: Malena

Ix:

Bloods: FBC, INR, LFTs

Imaging: OGD - distended veins in lower oesophagus

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4
Q

In a haematemesis Hx, what will examination/Hx finding show if it is a peptic ulcer?

What Ix will be useful?

A
  • Abdominal pain
  • NSAID use
  • Smoker
  • PMHx of Peptic ulcer

Worse with food = gastric

better with food = duo

Ix finding:

FBC

Urea breath test: positive for H. Pylori

  • H. Pylori is the most common cause of duo and gastric ulcers; nsaids more gastric

Upper Gi endoscopy

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5
Q

In a haematemesis Hx, what will examination/Hx finding show if it is a malignancy?

What Ix will be useful?

A

dysphagia (discomfort/difficulty swallowing), PMHx, FHx, drinker and smoker

Weight loss, early satiety,

fever, night sweats, weight loss

Ix: Upper GI endoscopy

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6
Q

In a haematemesis Hx, what will examination/Hx finding show if it is a bleeding disorder?

A
  • Medication Hx - warfarin
  • PMHx e.g.
    • haemophilia (lack of CF - particulerly #8),
    • von williebrand (missing or VWF that + F8, and platelets in blood vessel walls, –>platelet plug)
      *
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7
Q

In a haematemesis Hx, what will examination/Hx finding show if it is a mallory-weiss tear?

What Ix would be useful?

A
  • Hx of retching, vomiting, coughing or straining
  • light headedness or dizziness

Ix: OGD: visible red longitudinal defect (tear)

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8
Q

What are the different ddx for a presentation of diarrhoea?

A
  • Gastroenteritis (norovirus or campyloacter - jejuni or coli)
    • a few days Hx
  • IDB
    • ~18y/o male w/ chronic diarrhoea
  • IBS
    • 20y/o female. diarrhoea + STRESS
  • Diverticular disease
    • Middle aged, RF: obesity and low fibre diet
  • Colorectal cancer
    • 55y/o male w/blood in loose stools

Importnant to consider: ODP Ass - follow the GI tract down, then screen for red flags, PMHx, travel, FHx, SHx

?Dehydration –> do they need fluids set up

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9
Q

In a diarrhoea Hx, what will examination/Hx finding show if it is gastroenteritis?

What investigations would be useful?

A
  • profuse WATERY diarrhoea
  • fever
  • Hx: foreign travel or eating poorly cooked foods
  • other family/household members sick

Ix:

  • stool MC&S
  • if concerned about parasites: serodiagnosis
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10
Q

In a diarrhoea Hx, what will examination/Hx finding show if it is IBD?

What investigations would be useful?

A
  • Ulcerative collitis
    • blood and mucus
    • crampy abdo pain
    • urgency
    • tenesmus (rectal involvement)
  • Crohns
    • mucus
    • colicky abdo pain
  • BOTH:
    • fever
    • weight loss
  • Ix:
  • FBC, CRP and ESR
  • Colonoscopy and biopsy
    • malaise
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11
Q

In a diarrhoea Hx, what will examination/Hx finding show if it is IBS?

What investigations would be useful?

A
  • triad:
  • constipation/diarrhoea mix
  • bloating
  • relief on defecation

Ix: its a functional disorder, rule out other things

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12
Q

In a diarrhoea Hx, what will examination/Hx finding show if it is diverticular disease?

What investigations would be useful?

A
  • bloody diarrhoea
  • abdo pain in LIF
    • if its diverticulitis:
      • _​_fever, nausea and vomiting

Ix: fbc, contrast enema (barium enema) [x-ray study that useing a water solublecontrast agent containing iodine or barium to show the structure of the rectum/colon/large intestine.

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13
Q

In a diarrhoea Hx, what will examination/Hx finding show if it is CRC?

What investigations would be useful?

A

RED FLAG SYMPTOMS - abdominal pain, change in bowel habit, weight loss and iron-deficiency anaemia.

~tenesmus, haematochezia - bloody stools, in or with (diarrhoea normally LS)

PMHx of malignancy, IBD or coeliacs

Ix:

Blood: FBC (anaemia) CRP, ESR, U&Es(Ca2+ ~ constipation and abdo pain + polydipsia and polyurea)

Colonoscopy and biopsy

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14
Q

What are the the Ddx for jaundice?

A
  • Alcoholic liver disease (alcoholic hepatitis)
  • Viral hepatitis (A, B, C)
  • Primary biliary sclerosis
  • Choleliathiasis
    • Female, Fat, Forty and Fertile
  • Pancreatic adenocarinoma (head of panc)
    • usually present with symptoms of mets, but in some cases ~jaundice
  • Chronic pancreatitis
    • 50 y/o alcoholic presents with jaundice and bloating
  • heamolytic anaemia
    • malaria, G6DP def, sickle cell

Important to consider: Red flags – PAINLESS JAUNDICE

always do an alcohol hx + CAGE

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15
Q

In a jaundice Hx, what will examination/Hx finding show if it is alcoholic liver disease (alcoholic hepatitis)?

What Ix would be useful?

A
  • Chronic alcoholic
  • pain
  • ascites
  • bruising
  • RUQ pain
  • Jaundice was rapid onset

Ix finding: LFTs - AST>ALT

[in alcoholism AST:ALT raised over 1.5. + GGT + icHDL are signs too]

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16
Q

In a jaundice Hx, what will examination/Hx finding show if it is Viral hepatitis?

What investigations would be useful?

A
  • Flu-like symptoms
  • IVDU
  • unprotected sex
  • tattoos
  • piercings
  • blood transfusions
  • travel

Ix: IgM anti- HAV

IgM anti-HBV

17
Q

In a jaundice Hx, what will examination/Hx finding show if it is primary biliary sclerosis?

What investigations would be useful?

A
  • PMHx of ulcerative collitis

Ix: ERCP - beads on a string

p-ANCA abs found (vasculitis abs)

18
Q

In a jaundice Hx, what will examination/Hx finding show if it is choleliathiasis?

What investigations would be useful?

A
  • Four F’s: Female, fat, forty and fertile
  • colicky abdominal pain,
  • pale stools dark urine
  • pruritus
  • pain after eating fatty meal

Ix: USS

19
Q

In a jaundice Hx, what will examination/Hx finding show if it is pancreatic adenocarcinoma?

What investigations would be useful?

A
  • painless obstructive jaundice
  • (and palpable gall bladder- murphys sign)
  • symptoms consistent with mets to lymph, liver, lungs

Ix:

Bloods: FBC, amylase, raised bilirubin and ALP (biliary tree–> check GGT too); CA199

Imaging: USS

20
Q

In a jaundice Hx, what will examination/Hx finding show if it is chronic pancreatitis?

What investigations would be useful?

A
  • Jaundice and bloating
  • steatorrhoea
  • weight loss and anorexia
  • boring pain- relieved on leaning forward
  • Chronic alcoholic

Ix: on AXR- calcification of the pancreas

21
Q

In a jaundice Hx, what will examination/Hx finding show if it is haemolytic anaemia?

What investigations would be useful?

A
  • recent travel (malaria)
  • FHx (sickle cell, G6DP)
  • PMHx

Ix:

  • FBC
  • Direct coombs test (autoimmune haemolytic anaemia)
  • blood film
22
Q

What are the Ddx for an abdominal distention (bloating) history?

A
  • Ovarian carcinoma
    • post memopausal women presents with feeling bloated for ~>3 weeks
  • Pregnancy
  • IBS
  • Liver disease
  • Medication
  • Bowel obstruction
    • acute onset
  • Chronic pancreatitis

Important to consider: ODP, Ass, PMHx and PSHx, DHx and SHx

  • past surgical history is important
  • in Social Hx - inlude and signpost for last menstrual period
23
Q

In a boating/abdo distention Hx, what will examination/Hx finding show if it is ovarian carcinoma?

What investigations would be useful?

A
  • post menopausal women presents with feeling bloated for ~3 weeks or more
  • Exam/Hx
    • loss of appetite
    • increased urgency and freiquency
    • bloating, ascites, pelvic or abdo mass
    • back pain
  • ix:
  • bloods: FBC, CA125
  • Imaging: USS
  • invasive: frozen section biopsy
24
Q

In a abdo distention/bloating Hx, what will examination/Hx finding show if it is primary biliary sclerosis?

What investigations would be useful?

A
  • Last menstural period

Ix: preg test

25
Q

In a abdo distention/bloating Hx, what will examination/Hx finding show if it is IBS?

What investigations would be useful?

A
  • bloating
  • constipation/diarrhoea
  • relief of pain on defecation

Ix: diagnosis of exclusion

26
Q

In a abdo distention/bloating Hx, what will examination/Hx finding show if it is liver disease?

What investigations would be useful?

A
  • jaundice
  • portal hypertension
  • varicies
  • chronic alcohol use
  • IVDU
  • travel

Ix:

Bloods: FBC, LFTs, INR, ESR, viral screen, MC&S urine and blood, ascited

LFTs: AST>ALT (alcohol)

ALT >AST = other cause of liver damage [if ratio below 1 then liver]

27
Q

In a abdo distention/bloating Hx, what will examination/Hx finding show if it is medication?

What investigations would be useful?

A
  • normally associated with constipation too
  • aspirin, opioids, antacids, iron supplements
28
Q

In a abdo distention/bloating Hx, what will examination/Hx finding show if it is bowel obstruction?

What investigations would be useful?

A

Small bowel:

  1. pain and vomiting
  2. distension
  3. constipation

Large bowel:

  1. pain and constipation
  2. distention
  3. vomiting
  • past surgical history

Ix: AXR - distended bowel loops

29
Q

In a abdo distention/bloating Hx, what will examination/Hx finding show if it is chronic pancreatitis?

What investigations would be useful?

A
  • jaundice
  • steatorrhoea
  • anorexia
  • weight loss
  • boring pain relieved on leaning forward

Ix:

AXR -calcification of the pancreas

30
Q

What should be considered in a dysphagia history?

A
  • timeline
  • no fluid or solid whole time - ?oesphageal achalasia
  • solids–>fluids –> ?oesophageal cancer
31
Q

What is are the criteria for OGD?

A

ALARMS-55

  • anaemia
  • loss of weeight
  • appetite
  • recent onset of progressive symptoms
  • malena
  • swallowing difficulties
  • over 55?
32
Q

What are the red flags for colon/endoscopy?

A

BOWELS - endoscopy

  • bloating
  • owch
  • weight loss
  • exhaustion
  • lasting urge (tenesmus)
  • swallow

OSCE 1 (24 decks)

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