GI history and examination Flashcards

1
Q

What should you enquire about in a GI history?

A
Pain
Abdominal distension
N&V
Dysphasia
Dyspepsia, hiatus hernia and peptic ulceration
Hx of gallstones/previous pancreatitis
Jaundice
Altered bowel habit, diarrhoea, constipation, alternating diarrhoea/constipation
Blood loss
Mucus/slime per rectum
Appetite
Weight changes
Continence
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2
Q

What should you ask in a vomiting history?

A

How frequent?
What time of day?
Taste/colour/smell/quantity?
Blood in vomit? Fresh altered blood?

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3
Q

What should you ask about in a dysphasia history?

A
Continuous/intermittent?
How long does it last for?
Where does the food stick?
Solids/liquids/both?
Does it occur between meals?
Do you suffer from acid reflux/dyspepsia?
Nocturnal coughing or dyspnoea?
Enquire about risk factors for oesophageal carcinoma - smoking, alcohol, obesity and diet lacking in fruit and veg
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4
Q

What should you ask in a jaundice history?

A
Colour of urine and stools?
Hx of gallstones?
Pain?
Fever and rigors?
Itching?
Social history - alcohol, drugs, foreign travel, unprotected sex
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5
Q

What should you ask in an altered bowel habit history?

A
How has the habit altered?
Frequency of stools?
Any associated abdominal discomfort or urgency?
Incontinence?
Appearance of stool?
Consistency (formed/unformed)?
Does it float?
Associated blood/pus/mucus?
Associated vomiting?
Foreign travel?
Medications including OTC?
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6
Q

What can cause rectal bleeding?

A
Haemorrhoids
Carcinoma
IBD
Anal fissures
Melena
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7
Q

What should you ask in a weight loss and loss of appetite history?

A

How much weight lost? Over how long?

Associated with loss of appetite or due to deliberate reduction in intake?

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8
Q

What should you ask about in a GI PM history?

A

Previous GI problems, diagnoses, effectiveness of treatment
Previous GI/abdominal surgery
Gynaecological problems
Hx of jaundice, anaemia, diabetes

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9
Q

What should you ask in a drug history?

A
Iron tablets
Opiates
NSAIDs
Antibiotics
Anticoagulants
SSRIs
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10
Q

What should you ask about in a social history?

A
Alcohol
Smoking
Occupation
Diet
Recent foreign travel
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11
Q

What should you ask about in a family history?

A
Cancers
Crohn's disease
Ulcerative colitis
Malabsorption syndromes
Gilbert's syndrome
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12
Q

What are the steps in a GI examination?

A
Inspection
Palpation
Percussion
Auscultation
Special tests
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13
Q

What should you inspect?

A
General inspection
Hands
Forearms and armpits
Eyes
Face 
Mouth
Chest wall
Abdomen - posterior and anterior
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14
Q

What should you look for in the hands?

A
Colour - pallor of palmar creases, palmar erythema
Temperature
Clubbing
Leukonychia
Koilonychia
Spider naevi
Dupuytren's contracture
Asterixis
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15
Q

What do you look for in the forearms and arm pits?

A

Muscle wasting
Bruising
Scratches suggestive of pruritis
Acanthosis nigricans

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16
Q

What should you look for in the eyes?

A
Jaundice
Anaemia
Xanthelasma
Corneal arcus
Kayser-Fleischer rings
17
Q

What should you look for in the face?

A

Telangiectasia

18
Q

What should you look for in the mouth?

A
Telangiectasia (HHT)
Pigmentation
Angular stomatitis (vit B6/12/folate/iron deficiency)
Glossitis (vit B12/folate deficiency/iron)
Dehydration
Halitosis
Dental caries
Ulcers
19
Q

What should you examine the chest wall for?

A

Spider naevi

Gynaecomastia

20
Q

What do you inspect the abdomen for?

A
Scars
Skin
Shape/symmetry
Movement during breathing
Visible swellings and masses
Visible peristalsis
Visible aortic pulsation
Distended veins
5Fs of abdominal fluid distension
21
Q

What do you palpate?

A
Pulse
BP
Lymph nodes in neck and lymph nodes in inguinal region
9 regions of abdominal wall
- Liver
- Spleen
- Bladder
- Kidneys
- Gallbladder
- Aorta
22
Q

Which lymph node is important to palpate?

A

Virchow’s lymph node in L supraclavicular fossa

23
Q

What do you percuss?

A

Liver
Spleen
Bladder
Ascites - shifting dullness

24
Q

What do you auscultate?

A

Bowel sounds

Aortic and femoral bruits

25
Q

How do you finish a GI examination?

A
ISHRUG
Inspection of inguinal lymph nodes
Stool sample
Hernial orifices
Rectal examination
Urine sample
Genitalia