GI exams Flashcards
What should you ask the patient before proceeding with any examination?
If they have any pain
List two conditions associated with hyperpigmentation of the skin.
Haemochromatosis
Addison’s disease
What is palmar erythema associated with?
Chronic liver disease
What does koilonychia indicate?
Iron deficiency anaemia
What abdominal conditions is finger clubbing associated with?
inflammatory bowel disease
liver cirrhosis
coeliac
liver cirrhosis
GI lymphoma
What are 3 possible causes of asterixis?
Hepatic encephalopathy
Uraemia
CO2 retention
What does Dupuytren’s contracture involve?
Thickening of the palmar fascia
What does acanthosis nigricans indicate?
Insulin resistance or gastrointestinal malignancy
What is the significance of Kayser-Fleischer rings?
Associated with Wilson’s disease
What does glossitis indicate?
Deficiencies in iron, B12, or folate
What is the first clinical sign of metastatic intrabdominal malignancy?
Enlargement of Virchow’s node - L supraclavicular
What does Cullen’s sign indicate?
Bruising around umbilicus associated with haemorrhagic pancreatitis
Fill in the blank: Caput medusae is associated with _______.
Portal hypertension
What does Grey-Turner’s sign indicate?
Bruising in the flanks associated with haemorrhagic pancreatitis
What should be assessed if a stoma is present?
Location
Contents
Consistency of stool
Spout presence
What does rebound tenderness indicate?
can be associated with peritonitis
What does Rovsing’s sign involve?
Palpation of the left iliac fossa causing pain in the right iliac fossa
appendicitis
What characteristics should be assessed if a mass is identified during deep palpation?
Location
Size and shape
Consistency
Mobility
Pulsatility
What is a palpable liver edge suggestive of?
Gross hepatomegaly
List 11 potential causes of hepatomegaly.
Hepatitis
Hepatocellular carcinoma
Hepatic metastases
Wilson’s disease
Haemochromatosis
Leukaemia
Myeloma
Glandular fever
Primary biliary cirrhosis
Tricuspid regurgitation
Haemolytic anaemia
What does a palpable gallbladder indicate?
Enlargement due to biliary flow obstruction or infection
Conditions include pancreatic malignancy or cholecystitis.
What does Murphy’s sign suggest?
Presence of cholecystitis
Indicated by pain when the patient stops mid-breath during palpation.
What are common causes of splenomegaly?
Portal hypertension
Haemolytic anaemia
Congestive heart failure
Splenic metastases
Glandular fever
What does a ballotable kidney suggest?
Enlarged kidneys
How do you palpate the aorta?
Perform deep palpation just superior to the umbilicus in the midline
What indicates a distended bladder during palpation?
Palpation in the suprapubic area arising from behind the pubic symphysis
What does dullness to percussion indicate during bladder assessment?
A distended bladder
What does an aortic bruit suggest?
Turbulent blood flow
Auscultated 1-2 cm superior to the umbilicus may be associated with an abdominal aortic aneurysm.
What further assessments are suggested for completeness?
ISHRUG
Inguinal lymph nodes
Stool sample
Hernial orifices
Rectal Exam
Urine dip
Genital Exam
where are colostomies typically located?
LIF
where are ileostomies and urostomies typically located?
RIF
what is the association with number of lumens in stoma and purpose?
1 lumen in RIF - end ileostomy/urostomy
1 lumen in LIF - end colostomy
2 lumens in RIF - loop ileostomy
2 lumens in LIF - loop colostomy
what does a spouted stoma mean?
presence of spout = ileostomy/urostomy - as cause skin irritation
no spout = colostomy
what kind of output comes from colostomies?
solid/semisolid faeces
what kind of output comes from ileostomies?
liquid or mushy bowel contents
what are 5 complications of stomas?
parastomal hernia
stoma prolapse
stoma retraction
stoma haemorrhage
stoma ischaemia/infarction
what are 4 features of parastomal hernia?
enlarged stoma
bulging of area behind stoma
increased size on coughing or sneezing
reducible mass
what does a stoma prolapse appear like?
elongation when patient stands, coughs or strains and reduction when lying
what is a complication of stoma retraction?
poor stoma bag attachment and frequent peristomal skin complications
what does stoma ischaemia appear like?
pain at stoma site
necrosis of stoma
how do hernias typically present on examination?
Single lump in the inguinal region
Positive cough impulse (unless incarcerated)
Soft on palpation
Reducible (unless incarcerated)
Unable to get above the lump during palpation
Painless (unless incarcerated)
Bowel sounds on auscultation (may be absent if incarcerated
where are inguinal hernias located?
above and medial to pubic tubercle and inguinal ligament
where are femoral hernias located?
below and lateral to pubic tubercle and inguinal ligament
what examination needs to be done with inguinal hernias?
scrotal examination - hernia may extend into scrotum
what is being examined for externally in PR exam?
skin excoriation
skin tags - associated with crohns
haemorrhoids
anal fissure
external bleeding
anal fistula
irregular growths - warts, cancer
Cough - rectal prolapse, internal haemorrhoids
what may be seen on general inspection in lymphoreticular examination?
Bleeding/bruising/petechiae - thrombocytopenia
abdo distention
pallor
cachexia
what characteristics should be assessed in an enlarged lymph node?
size
site
shape
consistency
tenderness
mobility
overlying skin changes
what are the characteristics of a benign lymph node?
<1cm, smooth round, non tender, mobile
what are the characteristics of a reactive lymph node?
smooth, round, tender, mobile, associated infective symptoms
what are the characteristics of lymphadenopathy due to haematological malignancy?
widespread, enlarged, rubbery lymph nodes
what are the characteristics of lymphadenopathy due to metastasis?
Hard, firm, irregular and tethered nodes
what areas need to be examined in a lymph node exam?
Cervical node
Axillary nodes
epitrochlear nodes - elbow
Inguinal nodes
Full Abdomen - for hepatomegally/splenomegally
what further assessments are required with lymph node exam?
FBC, blood film, US node
Biopsy of suspect node
Examination of relevant organ if mets are suspected
How do you measure insertion length of NG tube?
Tip of nose to tragus to xiphisternum
what pH suggests correct NG placement?
<4
what are some risks of NG insertion?
aspiration pneumonia
Trauma and bleeding
Tube dislodgement
Nosebleed
sore throat
