GI Exam

Question 1

Causes of clubbing in GI exam

Answer 1

MILC (Malabsorption e.g. coeliac, Inflammatory e.g. UC + crohns, Lymphoma, Cirrhosis

Question 2

Causes for distension

Answer 2

Flatus, Fluid, Faeces, Fat, Fetus

Question 3

Bedside signs of cushing’s or steroid induced obesity

Answer 3

Moonface
Striae
Abdo obesity

Question 4

Cause of koilonychia

Answer 4

Fe def

Question 5

Cause of leuconychia

Answer 5

Hypoalbuminaemia in nephrotic syndrome and liver failure

Question 6

Cause of ascites

Answer 6

Portal venous thrombosis
Hepatic vein thrombosis
Hepatitis
Pancreatitis
Hepatic failure
Heart failure
Malignancy

Question 7

Cause of duyputrens contracture

Answer 7

Alcoholism
Cirrhosis
Diabetes

Question 8

What is virchow’s node?

Answer 8

LEFT supraclavicular node

Sign of GI carcinoma

Question 9

Cause of gynaecomastia

Answer 9

Liver cirrhosis or iatrogenic (e.g. digoxin, spironolactone)

Due to testosterone: oestrogen imbalance

Question 10

GI finding of raised oestrogen

Answer 10

5+ spider naevi

Palmar erythema

Question 11

Cause of angular stomatis and glossitis

Answer 11

Fe, B12, folate (B9) def

Question 12

Stoma types

Answer 12

o	End colostomy (at left iliac fossa.)
o	Ileostomy (at right iliac fossa)
o	Loop colostomy + ileostomy (function: To protect distal anastomoses after recent surgery)
o	Urostomy (at right iliac fossa. Function: After cystectomy)

Question 13

Sign of retroperitoneal bleed

Answer 13

Retroperitoneal bleed in AAA rupture and acute pancreatitis

SIgn: Cullens and grey-turners sign

Question 14

Cause of abdo pain??

Epigastric:

Peri-umbilical:

RUQ:

LUQ:

LIF:

RIF:

Answer 14

Epigastric: PUD, GORD, MI, Pancreatitis, cholecystitis

Peri-umbilical: SI or LI obstruction, AAA, Appendicitis (early), mesenteric ischaemia

RUQ: Cholecystitis, hepatitis, asc cholangitis, Pneumonia, Pyelonephritis

LUQ: Pneumonia

LIF: Diverticular, UC, CD, Inguinal hernia, test torsion, Ovarian torsion, IBS, Ectopic, Endometriosis, GE, ureteric colic, UTI

RIF: Appendicitis, IBD, IBS, UTI, ureteric colic, GE, Test torsion, Endometriosis, ovarian torsion, ectopic preg, inguinal hernia

Question 15

Cause of hepatomegaly

Answer 15

** Cancer, cirrhosis, infection, RHF

o Cancer: Primary or mets*, haematological cancer
o Infection: EBV, Hepatitis, schisto, cyst/abscess
o Hepatic congestion in RHF
o Metabolic: Cirrhosis, Fatty liver
o Hepatic vein thrombosis (in Budd-chiari)
o Normal variant in Riedels lobe

Question 16

What is courvoisier’s sign?

Answer 16

Painless jaundice and palpable gallbladder.

Question 17

How to differentiate spleen from enlarged kidney

Answer 17

Cannot get above it
Spleen has palpable medial notch
Dull to percussion
Moves towards RIF with inspiration

Question 18

Causes of splenomegaly

Answer 18

** INFECTION, PORTAL HTN

o Infection: Viral (EBV, CMV, Rubella), Bacterial (TB, typhoid, syphilis), parasitic (schisto, malaria)
o Malignant (lymphoma, leukaemia, metastases)
o Haematological (thalassaemia, sickle cell disease, myelofibrosis, hemochromatosis)
o Connective tissue disorder: Rheumatoid, SLE
o Store disorders /metabolic: Glycogen storage disease, porphyria, amyloidosis, sarcoidosis
o Other: Cirrhosis, portal hypertension, graves

Question 19

Enlarged kidneys cause

Answer 19

Hydronephrosis

PKD

Question 20

Bowl sounds
Gurgling?
Absent?
Rigid?
Tinkling?

Answer 20

• Gurgling = Normal
• Absent= Paralytic ileus
• Rigid abdomen= Peritonitis
• Tinkling= Obstruction