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Phase 2B > GI Examination > Flashcards

GI Examination Flashcards

1
Q

What mnemonic is used to remember the causes of clubbing

A

CLUBBING

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2
Q

Name the causes of clubbing

A

C - cyanotic heart disease/cystic fibrosis
L - Lung cancer/lung abscess
U - Ulcerative colitis
B - Bronchiectasis
B - Benign mesothelioma
I - Infective endocarditis/idiopathic pulmonary fibrosis
N - Neurogenic tumours
G - Gastrointestinal disease

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3
Q

What are the GI causes of clubbing

A

Malnutrition - UC, chrons and coeliac
Cirrhosis
GI lymphoma

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4
Q

What sign is present in clubbing

A

Schamroth’s sign

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5
Q

Describe Schamroth’s sign

A

In clubbing - window obliterated as distal angle increases and becomes wider caused by uniform swelling

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6
Q

Summarise Dupuytren’s contractures

A

Development of cords within the palmar fascia leading to contracture and flexion deformity - often ring finger

Fibrosis and shortening of the palmar aponeurosis

Usually idiopathic or familial. Is a possible link to trauma, diabetes, epilepsy, alcoholism and liver disease

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7
Q

In a GI exam what is Dupuytren’s contracture a possible sign of

A

Excess alcohol

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8
Q

What are the possible causes of Dupuytren’s contractures

A

Excess alcohol
Manual work (vibrations)
Smoking (x3)
DM (1 in 5)
70% hereditary

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9
Q

Describe a liver flap

A

Asterixis

Metabolic encephalopathy

Cock hands backwards - 30 seconds

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10
Q

What is acanthosis nigricans a sign of

A

Insulin resistance

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11
Q

In a GI exam what is bruising a sign of

A

Synthetic liver failure

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12
Q

What is the key lymph node in a GI exam

A

Left supraclavicular node - marker of gastric cancer

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13
Q

What enlarged lymph node can be a marker of GI cancer

A

Left supraclavicular node

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14
Q

What is conjunctival pallor a sign on

A

Severe anaemia

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15
Q

Define conjunctival pallor

A

Paleness on anterior rim of conjunctiva

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16
Q

Describe Kayser Fleicher rings

A

Dark rings encircle the iris

Wilson’s disease - abnormal copper

Brown rings that encricle the iris - resulting from copper deposition.

Early stages is seen with a silt lamp - later can be seen with the naked eye

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17
Q

Define angular stomatitis

A

Inflammation around the corners of the mouth

Sore corners of mouth

May be caused by deficency of vitamin B6, B12, folate or iron

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18
Q

Define glossitis

A

Abnormal smooth red apparence of the tongue

Painless = iron de

Piandul glossitis = vitamin B12 or folate deficenct

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19
Q

What is glossitis associated with

A

Painful - Iron, B12, Folate deficiency - think malabsorption (IBD)

Painless - Iron deficency

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20
Q

What is oral candidiasis associated with

A

Immunosuppression

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21
Q

Define aphthous ulceration

A

Round/oval ulcers on mucus membrane inside the mouth

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22
Q

Name the causes of aphthous ulceration

A

Usually - Benign (stress, mechanical trauma)

Other - iron, B12, folate deficiency, chron’s disease

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23
Q

When would hyperpigmented macules on the face be seen

A

Peutz-Jeghers syndrome

Autosomal dominant genetic disorder = polyps in the GI tract

Associated with small bowel hamartomas

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24
Q

What is the cause of spider naevi

A

Increased levels of oestrogen

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25
Q

Name the causes of spider naevi

A

Liver cirrhosis

Normal in pregnancy and women taking oral contraceptive pill

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25
Q

What is the cause of gynaecomastia

A

enlarged breast tissue

Increased levels of oestrogen

Liver cirrhosis (liver failure)

Medications - digoxin, Spirolactone

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25
Q

When would you think spider naevi is caused by liver cirrhosis

A

> 5

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26
Q

Name 3 signs on the chest of increased oestrogen levels and what would this point towards

A

Spider naevi
Gynaecomastia
Decreased hair

Point towards liver cirrhosis

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27
Q

What are the causes of abdominal distension

A

6Fs

Fat, fluid, flatus, foetus, faeces, fulminant mass

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28
Q

What is the mnemonic for abdominal distension

A

6Fs

Fat, fluid, flatus, foetus, faeces, fulminant mass

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29
Q

Define caput medusae

A

Enlarged paraumbilical veins = portal hypertension (liver cirrhosis)

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30
Q

Name 2 late signs of haemorrhagic pancreatitis

A

Greys Turners sign

Cullens sign

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31
Q

Describe cullens sign

A

C bruising around umbilicus

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32
Q

Describe grey turners sign

A

T flank bruising

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33
Q

Name a stoma found on the right iliac fossa, spouted and liquid stool

A

Ileostomies

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34
Q

Name a stoma found on the right iliac fossa, spouted containing urine

A

Urostomies

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35
Q

What are the two types of stoma found on the right iliac fossa

A

Ileostomies
Urostomies

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36
Q

Name a stoma found on the left iliac fossa, flushed to the skin and containing stool

A

Colostomies

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37
Q

Why is a stoma spouted

A

Due to risk of damage to the skin if the contents make contact

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38
Q

Describe rebound tenderness

A

Wall compressed slowly

When released rapidly = sudden sharp pain

Non-specific. Unreliable

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39
Q

Describe voluntary guarding

A

Contraction of abdominal muscles in response to pain

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39
Q

Describe involuntary guarding

A

Involuntary tension of abdominal muscles occurring on palpitation of peritonitis

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39
Q

In what conditions may involuntary guarding be present

A

Appendicitis
Diverticulitis

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40
Q

Define Rovsing’s sign

A

Palpitation of left iliac fossa causes pain in right iliac fossa

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41
Q

Define Murphy’s sign

A

R. costal margin pain on deep inspiration causes halting on inspiration

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42
Q

Why does the Murphy’s sign occur

A

Gallbladder comes in contact with hand causing pain

Acute cholecystitis

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43
Q

Palpitation of the liver how far away from the liver suggests hepatomegaly

A

> 2cm

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44
Q

What does a nodular consistency of the edge of the liver indicate

A

Cirrhosis

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45
Q

What does hepatic tenderness suggest

A

Hepatitis or cholecystitis (may be gallbladder)

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46
Q

What is pulsatile hepatosmegaly caused by

A

Tricuspid regurgitation

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47
Q

On a GI exam is the gallbladder palpable

A

No

If palpable - enlargement secondary to biliary flow obstruction

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48
Q

What does tenderness of the gallbladder suggest

A

Cholecystitis

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49
Q

What does a distended painless gallbladder suggest

A

Pancreatic cancer

50
Q

How does a gallbladder feel on palpitation

A

Palpitation at a r. costal margin in the mid-clavicular line

Well rounded mass that moves with respiration

51
Q

Should a spleen be palpable on a GI examination

A

Healthy = not palpable

Palpable = 3x size

52
Q

What level is bifurcation of the aorta

A

L4

53
Q

What would pulsation of the bifurcation of the aorta on a GI examination suggest

A

Triple A

54
Q

In a healthy person should the bladder be palpable

A

No

55
Q

How do you percuss the spleen

A

RIF to left hypochondrium (left costal margin) whilst the patient takes deep breaths

When advance to the left costal margin - use right hand to palpate. Roll pateint slightly towards you - place left hand posterioly. This may bring a tip of a moderatley enlagred spleen towards you.

Only becomes palpable when 2-3x its normal size

56
Q

How do you percuss the liver

A

RIF to right hypochondrium whilst taking a deep breath

Hand palpate deep feel for desceding edge being push down by diaphgram

Normal = liver palpate 1cm below the right costal margin on deep inspiration
Galllbladder = not usually palpable unless enlarged

57
Q

How do you locate the liver by percussion

A

Move 1-2cm up until note changes from resonant to dull

Indicates the location of the lower liver border

58
Q

How do you locate the spleen by percussion

A

Move 1-2cm until the note changes from resonant to dull - full inspiration then full expiration. Percuss area lowest intercostal space - 8th or 9th rib in left axillay line

Indicates location of the spleen

59
Q

Should the spleen by able to be percussed on an abdominal exam

A

Healthy = not identifiable

Splenomegaly = identifiable

60
Q

How do you percuss the bladder

A

Percuss downwards in the midline from umbilical region towards the pubic symphysis

61
Q

What would a distended bladder feel like on percussion

A

Dull to percuss - allows approximate bladder’s upper border

62
Q

When should shifting dullness be completed on an abdominal examination

A

Only if ascites

63
Q

Describe how shifting dullness is examined

A

Percuss umbilical region to l. flank - dullness suggests the presence of ascites if fluid in the flank

Keep fingers where it became dull - ask to roll onto r. side (towards you for stability)

Keep patient there for 30 seconds - repeat percussion in same area

64
Q

Describe what would be found on an abdominal examination if ascites where present

A

Area which was dull to percuss when laying down will be resonant when on side (dullness has shifted)

65
Q

Describe the bowel sounds of a normal bowel

A

Gurgling every 6 seconds

66
Q

Describe the sounds of a bowel obstruction

A

Tinkling bowel sounds

67
Q

Describe the bowel sounds of an ileus (peristalsis)

A

Absent bowel sounds

68
Q

How many minutes do you have to listen to bowel sounds to be confident of diagnosis

A

3 minutes

69
Q

What do vascular bruits suggest

A

Turbulent blood flow

70
Q

To find aortic bruits were do you auscultate

A

1-2cm superior to umbilicus - bruit associated with AAA

71
Q

To find renal bruits were do you auscultate

A

1-2cm superior to umbilicus - slightly lateral to midline on each side

72
Q

What is a renal bruit associated with

A

Renal artery stenosis

73
Q

What Gi cause is associated with pitting oedema

A

Hypalbuminaemia due to liver cirrhosis (protein losing enteropathy)

74
Q

What mnemonics is used to complete a GI examination

A

SHURG

75
Q

Describe SHRUG

A

Stool sample
Hernia orifices (femoral and inguinal)
Rectal examination
Urinalysis
Genitals

+ inguinal lymph nodes

76
Q

What does pallor of the palmar suggest

A

Anaemia

77
Q

What is the cause of palmar erythema

A

Increased circulating oestrogens in liver failure

78
Q

What are the different forms of leukonychia

A

Leukonychia partialis
Terry’s nails/leukonychia totalis

Leukoncyhia partialis - small isolated patches - seen on trauma. If striae effects all nails - chemotherapy

Leukonchia totalis - due to hypoalbuminae

79
Q

Describe leukonychia partialis

A

Small isolated white patches or striae - normal in normal response to minor trauma to the germinal matrix

If affects all nails may be following a course of chemotherapy

80
Q

Describe leukonychia totalis/Terry’s nails

A

Whitening of the entire nail occurring in hypoalbuminemia

81
Q

Name the possible causes of leukonychia totalis/terry’s nails

A

Due to hypoalbuminemia

Nephrotic syndrome
Liver failure
Protein malabsorption
Protein-losing enteropathies

82
Q

What is the formal name for spoon shaped nails and what is the cause

A

Koilonychia

Suggests chronic iron deficiency

83
Q

Describe the examination of hands in a GI examination

A

Examine the front and back of the hands

Nails

Temperature

Asterixis

Pulse and BP

Forearms - muscle waiting and scratching

84
Q

Describe how asterixis are investigated on a GI examination

A

Hyperextend wrists and maintain position for 15 seconds

Coarse flapping tremor suggests liver failure with failure of ammonia metabolism to urea

Can be seen in renal failure and respiratory failure in CO2 retention

85
Q

In a GI examination what are you checking the forearms for

A

Muscle wasting

Scratches - suggestive of pruritis (itching)

86
Q

What other name is given to asterixis

A

Liver flap

87
Q

Name 5 things you are looking for on an eye examination

A

Jaundice
Subconjunctival pallor
Xanthelasma
Corneal arcus
Kayser-Fleischer rings

88
Q

Define xanthelasma

A

Yellow bumps on or near eyelid caused by cholesterol deposits

89
Q

Define corneal arcus

A

Lipid accumulate in peripheral cornea - forms grey ring around iris

90
Q

In early stages of Kayser-Fleischer rings due to Wilson’s disease how are they best seen

A

Slit lamp

91
Q

Define Telangiectasia

A

Small dilated blood vessels - looking on GI examination on the face

92
Q

Name features that you would be looking for on a GI examination

A

Telangiectasia
Pigmentation
Angular stomatitis
Glossitis
Dehydration
Halitosis (bad breath)
Dental caries
Ulcers

93
Q

Define halitosis

A

Bad breath

94
Q

What can angular stomatitis (sore corners of the mouth) be caused by

A

Deficiency of vitamin B6., B12, folate or iron

95
Q

What can painful glossitis (abnormal smooth red appearance of the tongue) be caused by

A

Deficiency seen in vitamin B12 or folate

96
Q

What can painless glossitis (abnormal smooth red appearance of the tongue) be caused by

A

Iron-deficiency

97
Q

What are two features that are examined on a GI examination of the chest

A

Spider naevi
Gynaecomastia

98
Q

Define gynaecomastia

A

Male breast development

May be due to increased circulating oestrogens in liver failure

99
Q

Define Troisier’s sign

A

Enlarged left supraclavicular lymph node (Virchow’s node) due to metastasis from an intra-abdominal malignancy

100
Q

Define Virchow’s node

A

Left supraclavicular lymph node

101
Q

What would be a sign of weight gain in an abdominal examination

A

Striae (stretch marks)

102
Q

Name what is inspected for on the abdomen on a GI examination

A

Scars, skin, skin lesions
Shape and symmetry
Movement during breathing
Visible swellings and masses
Visible peristalsis
Visible aortic pulsation
Distended veins

103
Q

What may distended veins in an abdominal inspection

A

May indicate inferior vena cava obstruction or portal hypertension

104
Q

What would the movement of the chest wall during breathing in an abdominal inspection suggest

A

Diaphragmatic ventilation usually ceases with acute peritonitis and ventilation is then via movement of chest wall

105
Q

Breakdown the definitions of the 5F’s of abdominal distention

A

Fluid (ascites)
Faeces (constipation)
Flatus (subacute intestinal obstruction)
Foetus (pregnancy)
Fat (obesity)

106
Q

What should be done on an abdominal examination if the stomach appears distended

A

Succussion splash

Shake the stomach brisky from side to side whilst listening for a sloshing sound

107
Q

How large must be spleen be to be palpable on palpation

A

2-3x its normal size

108
Q

Define Courvoisier’s Law

A

States that in the presence of a palpable gallbladder + jaundice is NOT likely to be gallstones

109
Q

Which kidney is rarely palpable even in thin people

A

Left

110
Q

If aorta is expansile what would this suggest

A

Aneurysmal dilation

111
Q

Define Murphy’s sign

A

Breathe out

Gently place hand below the right costal margin in the midclavicular line (approximate location of gallbladder)

Positive = inspiration is prevented due to inflamed bladder coming into contact with examiners fingers

112
Q

Where is the superior border of the liver

A

6th rid mid-inspiration

113
Q

What could cause the liver to be displaced downward which would give the false impression of hepatomegaly

A

In respiratory diseases e.g. emphysema

114
Q

Using the Castell’s method to percuss the spleen what would be a positive sign

A

Note changes from resonant on full expiration to dull on full inspiration

115
Q

What is a resonant note on full expiration when percussing the spleen likely to be due to

A

Air-filled stomach or splenic flexure of colon

116
Q

When percussing the spleen what would be a sign of splenomegaly

A

Dull percussion will be present when the inferior pole reaches the 8th or 9th intercostal space

117
Q

If an elderly patient presents with epigastric pain - what test should be commenced? What is a key differential?

A

Troponin

Inferior MI may present with epigastric pain

118
Q

Name the differentials associated with epigastric pain

A

Oesophagitis
Gastritis
Myocardial infarction
Peptic ulcer
Pancreatitis

119
Q

Name the differentials of right upper quadrant pain

A

Cholecystitis
Cholangitis
Biliary colic
Hepatitis
Duodenal ulcer
Pneumonia

120
Q

Name the differentials of left upper quadrant pain

A

Sphenic pain - enlargement, infarction, rupture

121
Q

Name the differentials of right iliac fossa pain

A

Appendicitis
Chron’s disease
Ectopic pregnancy
Renal stones
Mesenteric adenitis
Torsion of ovarian cyst

122
Q

Name the differentials of left iliac fossa pain

A

Diverticulitis
Ectopic pregnancy
Renal stone
Mesenteric adenitis
Torsion of ovarian cysts

123
Q

Name the differentials of flank pain

A

Renal colic
Pyelonephritis

124
Q

Name the differentials of suprapubic pain

A

Urinary tract infection
Testicular torsion
Miscarriage
Pelvic inflammatory disease

125
Q

What are the risk factors of GI

A

Pre-existing Gi diseases

Family history of Gi disease

Alcohol

Smoking

Recreational drugs

Diet

126
Q

What is the key family history you are asking for in a GI examination

A

Familial adenomatous polyposis

127
Q
A

Phase 2B (15 decks)

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