GI Presentations Quiz

Question 1

• 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

Answer 1

Acute Cholecystitis

Question 2

• fever, rigors
• loin pain
• nausea/vomiting
• symptoms of cystitis may be present:
  dysuria
  urinary frequency
  urinary urgency

Answer 2

acute pyelonephritis

Question 3

• epigastric pain
• nausea
• epigastric pain when hungry, relieved by eating

Answer 3

Duodenal ulcer

Question 4

epigastric pain
nausea
epigastric pain worsened by eating

Answer 4

gastric ulcer

Question 5

• 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

Answer 5

acute appendicitis

Question 6

• 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

Answer 6

Inguinal hernia

Question 7

• 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.

Answer 7

femoral hernias

Question 8

• 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

Answer 8

Crohns

Question 9

• bloody diarrhoea
• urgency
• tenesmus
• abdominal pain, particularly in the left lower quadrant
• extra-intestinal features (see below)

Answer 9

Ulcerative Collitis

Question 10

Chronic history of:
Intermittent abdominal pain: particularly in the left lower quadrant
Bloating
Change in bowel habit: constipation or diarrhoea

Answer 10

Diverticular disease

Question 11

• 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

Answer 11

Acute diverticulitis

Question 12

• 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

Answer 12

acute pancreatitis

Question 13

• 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

Answer 13

small bowel obstruction

Question 14

• 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

Answer 14

large bowel obstruction

Question 15

• severe, central abdominal pain radiating to the back
• pulsatile, expansile mass in the abdomen
• patients may be shocked (hypotension, tachycardic) or may have collapsed

Answer 15

ruptured AAA

Question 16

abdominal pain is typically severe, of sudden onset and out-of-keeping with physical exam findings.

Answer 16

acute mesenteric ischamia (caused by embolus)

Question 17

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

Answer 17

Bowel Ischaemia

Question 18

constipation
abdominal bloating
abdominal pain
nausea/vomiting

Answer 18

volvulus

Question 19

• 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.

Answer 19

oesophageal varicies

Question 20

• Typically brisk small to moderate volume of bright red blood from the mouth following a bout of repeated vomiting.
• Malena rare.
• Usually ceases spontaneously.

Answer 20

Mallory Weiss Tear

Question 21

• 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.

Answer 21

haemorrhoids

Question 22

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

Answer 22

pilonodal sinus

Question 23

• 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

Answer 23

fistula in ano

Question 24

• 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.

Answer 24

Perianal Abscess

Question 25

• painful, bright red, rectal bleeding
• around 90% occur on the posterior midline.
• if found in alternative locations then other underlying causes should be considered e.g. Crohn’s disease

Answer 25

anal fissure

Question 26

• Rectal mucus discharge
• faecal incontinence
• PR bleeding
• visible ulceration
• Full thickness starts internally so rectal fullness, tenesmus, repeated defecation
• DRE shows weakened sphincter

Answer 26

Rectal prolapse

Question 27

• Perianal pain
• perianal bleeding
• A palpable lesion
• Faecal incontinence

Answer 27

Anal cancer

Question 28

• Watery stools
• may have bloody stools
• abdominal cramps
• N and V
• acute onset

Answer 28

Gastroenteritis

Question 29

• anaemia
• gastrointestinal (GI) bleeding
• if upper GI then may be melena
• if lower GI then may present as brisk, fresh red PR bleeding

Answer 29

angiodysplasia

Question 30

• change in bowel habits
• rectal bleeding
• abdo pain or discomfort
• unexplained weight loss
• anaemia
• signs of bowel obstruction

Answer 30

Colorectal cancer

Question 31

abdo pain
distention of the abdomen
fever
tachycardia
guarding
dehydration.

Answer 31

toxic megacolon