GI exam and history Flashcards
What are you looking for in general inspection?
Sputum pots Sick bowels Medication Peg feed Not jaundice--> colour of the patient
What are you looking for in the hand?
Clubbing Leuconychia Koilonychias Palmar erythema Pale palmar creases Spider naevi Dupytren’s contracture
What does Leuconychia indicate?
Hypoalbuminaemia
What does Koilonychias indicate?
Iron deficiency anaemia
What does Palmar erythema indicate?
Chronic liver disease
What does Pale palmar creases indicate?
aneamia
What does spiner naevi indicate?
Liver disease
What does Dupytrens Contracture indicate?
Liver cirrhosis
Seen in alcoholics and in FHx
What is hepatic flap a indication of?
Liver failure
What does liver failure cause?
Hepatic encephalopathy–> confusion, altered consciousness and coma state
What does clubbing indicate?
Inflammatory bowel disease, Coeliac disease and cirrhosis
Do you do a pulse check in GI exam?
yes
What are the signs you are looking for around the eyes?
Jaundice
Conjuctive pallor
Xanthelasma
What do you look in the eye for jaundice and what does it indicate?
In the sclera
Cirrhosis and iarbily obstruction
What does Xanthelasma indicate?
Hyperlipidaemia
What does pale conjuctival indicate?
Anaemia
What are you looking for in the mouth?
Angular stomatis Oral candidas Mouth ulcers Glossitis Odor
What does Glossitis indicate?
Smooth swelling of the tongue
Indication of B12/iron/folate deficiency
What does oral candidas indicate?
It is thrush
Indication of Iron deficiency/ immunodeficiency
What does mouth ulcers indicate?
Chrons or coeliac disease
What does angular stomatitis indicate?
B12/iron deficiency
What nodes do you palpate?
Supraclavicular, virchows, axilliary and femoral
What signs are you looking for on inspection of abdomen?
Scars Colles sign Grey Turners Sign Spider neavi Gynaecomastia Hair loss Pulsation Striae Stomas Abdominal distention Caput medusae
What scars would you see and what surgery does that indicate?
Midline–> laparotomy
RIF –> Appendectomy
Right inferior to subcostal–> Cholecystectomy
What is colles sign?
Bruising around the umbilicus
What is Grey Turners sign?
Bruising around the flanks
What does Colles and Grey Turners sign indicate?
Retro peritoneal beading causes by ruptured AAA or pancreatitis
Having 5 or more spider neavi can be a indication of?
Can be due to Chronic liver disease
What is the cause of gynaecomastia (over production of the mamillary gland)?
Sign of liver Cirrhosis
or
S/E of Digoxin or Spirolactone
What is caput meduase and what does it indicate?
Engorgement paraumbilical veins.
Indicates portal hypertension
What does red pink striae indicate?
New abdominal distension
What does silver white striae indicate?
Chronic abdominal distension
What does hair loss in the abdomen indicate?
Malnourishment, iron deficiency anemia
What is the first thing you ask before palpate the stomach?
Ask if they have any pain and where?
Then go to their last
When palpating the abdomen what are you trying to identify? As well as looking at their face for signs of pain
Tenderness
Rebound tenderness –> peritonitis
Mass
Guarding
When you have identified the mass what do you describe?
Location Size Shape Consistency Mobility Pulsatile
What organs are you palpating for organomegaly?
Aorta Spleen Liver Kidney Bladder Gall bladder
What causes pulsatile enlarged liver?
Tricuspid regurgitation
What is the cause of a tender liver?
Hepatitis
What two bruits do you try and identify in abdo examination?
Aorta and renal bruits
What is the acronym used for end pieces?
SHRUGT
What does SHRUGT stand for?
Stool sample Herniation inguinal R--> Pr Urinalysis and pregnancy test Genitalia examination Temperature
What is shifting dullness trying to investigate?
Fluid in the abdomen (ascites)
In a history of Altered Bowel habit.
What questions would you ask?
How altered? For how long? Age of Patient?
Diarrhoea +/- vomiting – Onset? Contacts? Travel?
Blood –> old or new blood
Mixed or separate
Constipation ~( codeine)
In a history of vomiting
What questions would you ask?
How long for? What do they vomit (blood?) Pregnant? Timing?
Type of blood fresh or coffee granules
Get any chest pain/acid reflux
In a history of melena.
What questions would you ask?
Where in bowel motion? How much and how long? Associated symptoms (of anaemia?)
What are the causes of melena?
Commonly due to acute or chronic peptic ulceration
Sometimes due to right sided colonic bleeding
Rarely due to small bowel bleeding
Iron tablets
What questions would you ask in a Jaundice patient?
Urine and stools. Urine is dark and stools are pale
Any itching?
Associated symptoms? Consider Family and especially social histories (transfusions, alcohol, travel, sex, drugs).
What questions would you ask in a dysphagia patient?
Continuous or intermittent? How long? Where does food stick? Solids, liquids or both? Acid reflux or dyspepsia? Consider risk factors for Ca.
In a change weight history station
What questions would you ask?
How much over how long? Loss of appetite or interest in food? Dieting? Associated symptoms are important because there are lots of possible diagnoses (not just GI).
What are the key past medical histories you should ask about?
Jaundice
Anemia
Diabetes
What drugs should you inquire about?
NSAIDS Iron tablets Abx SSRIS Opiates Laxatives
If a patient has gall bladder what examination would illicit the symptoms?
Murphy’s sign
What is Murphy’s sign?
The patient is asked to inhale while the examiner’s fingers are hooked under the liver border at the bottom of the rib cage.
The inspiration causes the gallbladder to descend onto the fingers, producing pain if the gallbladder is inflamed.
What is a sign of acute appendacitiesʔ
Pain at Mcburny’s point
Where is Mcburny’s pointʔ
1/3rd between the ASɪS and umbilical
ɪn general pain in the right hypochondriac is a indication of disease in what organʔ
ɢive example of disease
ʟiver
Cholangitis
ɢall bladder
ʟiver abscess
ʜepatitis
ɪn general pain in the lefthypochondriac is a indication of disease in what organʔ
ɢive example of disease
Spleen
Spleen rupture, abscess
Acute splenomegaly
ɪn general pain in the epigastrium is a indication of disease in what organʔ
ɢive example of disease
Peptic ulcer Esophagitis Perforating ulcer ɢOʀD Pancreatitis
ɪn general pain in the right and left lumbar is a indication of disease in what organʔ
ɢive example of disease
ʀenal
Pylenophritis
Ureteric colic
ɪn general pain in the umbilical is a indication of disease in what organʔ
ɢive example of disease
Small bowel diseae
Merckel’s diverticulum
Early appendicitis
ɪn general pain in the left iliac is a indication of disease in what organʔ
ɢive example of disease
Diverticulitis ʜernia Ulcerative colitis Ovarian cyst Constipation
ɪn general pain in the hypograstic is a indication of disease in what organʔ
ɢive example of disease
Urinary retention
Cystitis
Testicular torsion
ɪn general pain in the right iliac is a indication of disease in what organʔ
ɢive example of disease
Ectopic pregnancy ʜernia Ovarian cyst Ceacum obstruction Chrons disease Appendicitis late
What is the three abx are given for acute appendacitisʔ
AMɢ
Amoxicillin
ɢentamicin
Metronidazole
What is the triad of symptoms for acute pyelonephritis?
Fever
Loin pain
Nausea and vomiting
If the patient indicates there is blood in the urine?
What 4 questions should you ask?
How much blood is their in the urine?
What colour is the blood? ( dark or bright)
Do you ever wee just blood and no urine ?
Is there any clots in the blood?
For a patient with UTI symptoms what questions relating to the urinating do you ask?
Frequency
Urgency
The colour and smell of the urine?
The flow of the urine (stream or dribbling)?
When patient has UTI/renal tract problems you should ask about there bowels. What should you ask?
Are your bowels working?
Are you incontinent?
What social history question is key in a UTI/renal tract infection history?
Sexual activity and for how long
If a patient says they have vomited what should you ask?
What was the content of the vomit? (blood, food, mixture, bile etc)
What is key to ask in a GORD history?
what makes it worse? (heavy faty food, spicy food, hot tea and alcohol).
What should you ask/consider in every history?
Pain, Bowel Habits, Blood Loss, Distension, Vomiting, Appetite, Weight Changes and Continence (both).
