GI Signs Flashcards
Mouth
Angular stomatitis- thiamine, B12, Fe deficiency
Ulcers- crohns
Glossitis- Fe, B12, folate deficiency
Dentition
Telangiectasia
Kayser fleicher rings green corneal margin wilsons disease.
Virchows node
Upper GI malignancy
Abdo inspection
Distension- ascites, ALD, nephrotic syndrome, ovarian CA, HF, TB, pancreatitis.
Scars
Pulsation
Striae
Spider naevi- ALD, pregnancy.
Skin changes
Gynaecomastia- ALD, heroin.
Grey turners sign flank bruising- retroperitoneal bleed eg pancreatitis.
Cullen’s blue around umbillicus- acute pancreatitis
Palpation
Rebound tenderness and guarding involuntary muscle contraction- peritoneal inflammation.
Mcburneys point and rovsings sign (palpation LLQ increases RLQ pain)- appendicitis.
Murpheys cholecytsitis.
Hepatomegaly causes
Malignancy
Hepatic congestion eg RHF
Anatomical
Infection eg hep, malaria, schistosomiasis, EBV.
Haematological eg leukaemia, lymphoma, SCD, haemolytic anaemia.
Other- fatty liver, amyloidosis.
Splneomegaly causes
CML
Myelofibrosis
Malaria
Amyloidosis
Pyelonephritis signs
Tachycardia and tachpnoea Loin to groin pain Haematuria Proteinuria Hypotension Palpable kidney
Steroid ADRs
OP Diabetes Gastric ulcer Reduced immunity Weight gain Thin skin Muscle wasting
GU vs DU
DU more common
DU pain relief by eat or drink milk. Worse 2-5 hr after eat.
GU pain associated with eating. Nausea and vomiting. Weight loss.
NSAID and Hp associated.
Hp triple therapy PPI, amoxicillin, clarithromycin.
DM drug ADRs
Metformin CI in renal failure, causes diarrhoea. Lactic anodises.
Sulphonylureas weight gain, hypoglycaemia.
Pre hepatic jaundice
Haemolysis
- lab- uncojugated hyperbilirubinaemia, reticulocytosis, anaemia, high LDH, low haptoglobin (binds free Hb released by breakdown).
- causes-
Inherited- RBC membrane defects, Hb abnormality, metabolic defects.
Congenital- Gilbert’s syndrome low gluconyl transferase.
Acquired- immune, mechanical, membrane defects, infection, drugs, burns.
Hepatoccellular jaundice
Cells cant conjugate or eliminate
- lab- Mixed bilirubinaemia, high AST and ALT, maybe high ALP, abnormal clotting.
- causes-
Congenital- Gilbert’s.
Inflammation- virus, autoimmune hepatitis, alcohol, haemochromatosis, wilsons.
Drugs- paracetamol.
Cirrhosis- alcohol, chronic hepatitis, metabolic disorder.
Tumour- HCC, mets.
Post hepatic
Cholestatic- intra or extra hepatic obstruction.
- lab- conjugated hyperbilirubinaemia, dark urine as bilirubin in it, no urobilinogen in urine, high ALP, maybe high AST and ALT.
- causes-
Intra- hepatitis, drugs, cirrhosis, primary biliary cirrhosis.
Extra- gallstone, stricture, pancreatitis, sclerosing cholangitis, CA (pancreas head, ampulla, BD, porta hepatic LNs, mets).
Hepatitis
Acute= jaundice, high ALT and AST.
Chronic= low albumin and CFs
Causes- viral, AI, drugs eg isoniazid, hereditary eg a1 antiT deficiency, wilsons.
Cirrhosis
- causes- alcohol, virus, biliary cirrhosis, AI hepatitis, haemochromatosis, wilsons.
- signs- jaundice, anaemia, bruising, palmar erythema, dupuytrens, flapping tremor. Portal HTN. Spontaneous becaterial peritonitis.
- tests- high ALT and AST, high ALP, high bilirubin, low albumin, poor clotting, low Na.
- tx- stop drinking, treat complications, transplant.
- Specific causes-
Primary biliary cirrhosis- chronic BD destruction.
Haemochromatosis- recessive. Iron deposition. Cardiomyopathy, DM, hypogonadism, hepatitis, hyperpigmentation.
Wilsons- recessive. Copper deposition. Affects basal ganglia= PD symptoms. Tubular degeneration.
A1 antiT deficiency- recessive. Cirrhosis and empyema.
Portal HTN
- causes- portal vein obstruction. Internal liver flow obstruction eg cirrhosis, sclerosis, schistosomiasis, sarcoidosis.
- signs- splenomegaly, ascites, spider naevi, caput, oesophageal and rectal varices.
Hepatic encephalopathy
Failure of liver to remove NH3
- precipitants- infection, constipation, diuretics, GI bleed, alcohol withdrawal.
- signs- flapping tremor, LOC, personality change, intellectual impairment.
Hepatic tumours
- benign eg haemangioma, liver cell adenoma, liver cyst.
- primary malignant- HCC
- secondary- COLORECTAL, neuroendocrine, pancreas, breast, stomach, lung, ovary, kidney.
Pancreatitis
- Acute- oedema, haemorrhage, necrosis
Causes- GET SMASHED- gallstone, ethanol, trauma, steroids, mumps, AI, scorpion, hyperlipidaemia, ERCP, drugs.
Pathogenesis- duct obstruction and reflux, damage acini, protease, lipase and elastase relaease.
Signs- severe pain, vomiting, dehydration, shock, ecchymosis, ilieus. - Chronic- fibrosis, calcification.
Causes- alcohol, CF, biliary disease.
Pathogenesis- presence also destruction, fibrosis, loss acini, duct stenosis.
Signs- pain, malabsorption, DM, jaundice.
Pancreatitis carcinoma
90% ductal adenocarcinoma.
Causes- smoking, familial pancreattis, drugs.
Signs- initially none, obstructive jaundice, pain, vomiting, malabsorption, DM.
Gilbert’s syndrome
Causes unconugated hyperbilirubinoaemia
Decrease UGT1 activity (conjugates bilirubin with glucuronic acid)
Diagnosis- slightly high bilirubin, normal FBC and reticulocytes.
Korsakoff syndrome
Hypothalamic damage and cerebral atrophy due to vitB1 deficiency eg alcoholics. May accompany wernickes encephalopathy.
Cant make new memories, confabulation, lack insight, apathy.
Wernickes encephalopathy
VitB1 deficiency (alcoholics) with classic triad- confusion, ataxia, opthalmoplegia.
Focal areas brains damage.
Untreated can progress to korsakoff.
Zollinger ellison
Gastrin secreting adenoma associated wth peptic ulcers.
Adenoma usually in pancreas, can be stomach or duodenum.
