GI Presentations Quiz Flashcards
- Right upper quadrant pain, may radiate to the right shoulder
- Fever and signs of systemic upset
- Murphy’s sign on examination: inspiratory arrest upon palpation of the right upper quadrant
- Liver function tests are typically normal
Acute Cholecystitis
- fever, rigors
- loin pain
- nausea/vomiting
- symptoms of cystitis may be present:
dysuria
urinary frequency
urinary urgency
acute pyelonephritis
- epigastric pain
- nausea
- epigastric pain when hungry, relieved by eating
Duodenal ulcer
epigastric pain
nausea
epigastric pain worsened by eating
gastric ulcer
- peri-umbilical and lower abdominal pain, radiating to the right iliac fossa
- patients often report the pain being worse on coughing or going over speed bumps
- vomiting once or twice, not usually persistant
- mild pyrexia
- anorexia
Examination:
- Rovsing’s sign (palpation in the LIF causes pain in the RIF) is now thought to be of limited value
psoas sign: pain on extending hip if retrocaecal appendix
-rebound tenderness with guarding and rigidity
acute appendicitis
- groin lump
- superior and medial to the pubic tubercle
- disappears on pressure or when the patient lies down
- discomfort and ache: often worse with activity, severe pain is uncommon
strangulation is rare
Inguinal hernia
- A lump within the groin, that is usually mildly painful;
- Typically non-reducible, although can be reducible in a minority of cases;
- a cough impulse is often absent.
femoral hernias
- presentation may be non-specific - - - – symptoms such as weight loss and lethargy
- diarrhoea
- may cause bloody diarrhoea (not common)
- abdominal pain
- perianal disease: e.g. Skin tags or ulcers
- extra intestinal features
Crohns
- bloody diarrhoea
- urgency
- tenesmus
- abdominal pain, particularly in the left lower quadrant
- extra-intestinal features (see below)
Ulcerative Collitis
Chronic history of:
Intermittent abdominal pain: particularly in the left lower quadrant
Bloating
Change in bowel habit: constipation or diarrhoea
Diverticular disease
- severe abdo pain in LLQ
- Nausea and vomiting
- Change in bowel habit
- Urinary frequency, urgency or dysuria (10-15%)
- PR bleeding
- tender LIF
- reduced bowel sounds
- Guarding over LIF
- palpable mass in LIF
Acute diverticulitis
- severe epigastric pain that may radiate through to the back
- vomiting is common
- examination may reveal epigastric tenderness, ileus and low-grade fever
- periumbilical discolouration (Cullen’s sign) and flank discolouration (Grey-Turner’s sign) is described but rare
acute pancreatitis
- diffuse, central abdominal pain
- nausea and vomiting
- typically bilious vomiting (early)
- ‘constipation’ and lack of flatulence
- abdominal distension may be apparent, particularly with lower levels of obstruction
- ‘tinkling’ bowel sounds
small bowel obstruction
- absence of passing flatus or stool
- abdominal pain
- abdominal distention
- nausea and vomiting are late symptoms that may suggest a more proximal lesion
- peritonism may be present if there is associated bowel perforation
- thought should be given to underlying causes - e.g. suggesting cancer
large bowel obstruction
- severe, central abdominal pain radiating to the back
- pulsatile, expansile mass in the abdomen
- patients may be shocked (hypotension, tachycardic) or may have collapsed
ruptured AAA
abdominal pain is typically severe, of sudden onset and out-of-keeping with physical exam findings.
acute mesenteric ischamia (caused by embolus)
abdominal pain - in acute mesenteric ischaemia this is often of sudden onset, severe and out-of-keeping with physical exam findings
rectal bleeding
diarrhoea
fever
bloods typically show an elevated white blood cell count associated with a lactic acidosis
Bowel Ischaemia
constipation
abdominal bloating
abdominal pain
nausea/vomiting
volvulus
- Usually a large volume of fresh blood out mouth
- Swallowed blood may cause melena. - Often associated with haemodynamic compromise.
- May stop spontaneously but re-bleeds are common until appropriately managed.
oesophageal varicies
- Typically brisk small to moderate volume of bright red blood from the mouth following a bout of repeated vomiting.
- Malena rare.
- Usually ceases spontaneously.
Mallory Weiss Tear
- Bright red rectal bleeding
- Post defecation bleeding noted both on toilet paper and drips into pan.
- May be alteration of bowel habit and history of straining.
- No blood mixed with stool.
- No local pain.
haemorrhoids
pain (may be severe)
purulent discharge
fluctuant swelling at the site
patients may describe cycles of being asymptomatic and periods of pain and discharge from the sinus
pilonodal sinus
- Present with either recurrent perianal abscesses OR intermittent/continuous discharge onto the perineum (faeces, blood, pus, mucus)
- External opening on the perinueum may be seen or covered in granulation tissue
- May feel fibrous tract under skin on DRE
fistula in ano
- Patients may describe pain around the anus, which may be worse on sitting;
- They may have also discovered some hardened tissue in the anal region;
- there may be pus-like discharge from the anus;
- the patient may have features of systemic infection.
Perianal Abscess
