GI week: Hx & Ex Flashcards
Cardinal symptoms in GI history
- painful mouth
- difficulty swallowing
- heartburn
- abdominal pain
- nausea, haematemesis
- bowels
- rectal bleeding
- flatulence
- jaundice
- fever
- weight loss
GI causes of clubbing
- Liver cirrhosis
- IBD
- malabsorption
What causes palmar erythema and spider naevi in GI conditions
Excess oestrogen due to reduced hepatic breakdown of sex steroids
Causes of leukonychia
conditions leading to lack of protein
- hypoalbunimaemia
- Kwashiokor (protein malnutrition)
- Coeliac’s (protein losing enteropathy)
- Nephrotic syndrome (prolonged proteinuria)
Causes of Dupytrene’s contracture
- Alcohol related chronic liver disease
- Congenital
- Diabetes
- Smoking
- High cholesterol
- HIV
What might bilateral parotid swelling indicate
- Chronic alcohol abuse
- Bulimia
Difference between telangiectasia and spider naevi
- direction of flow
- blanching characteristics
Telangiectasia flow from outside in
Spider naevi flow from inside out
Telangiectasia do not blanch with pressure
Spider naevi blanch with pressure
What GI condition might mouth ulcers indicate
Crohn’s
What are iritis and episcleritis associated with
IBD (Crohn’s, UC)
What might glossitis and angular stomatitis indicate
Iron deficiency anaemia/ B12/ folate deficiency
How to feel difference between expansile and pulsatile aorta on palpation
Expansile: fingers pushed apart from each other
Pulsatile: fingers pushed away from abdomen
What 4 features on examination indicate liver failure
- Fetor hepaticus (stale mousy smell)
- Flapping tremor
- Varied mental state (from drowsy to coma)
- Late neurological features - spasticity and extension of arms and legs. Extensor plantar responses
Peptic ulcer and duodenal ulcer
- in which do you lose/ gain weight
Lose weight with peptic ulcer
Gain weight with duodenal ulcer
What do the following GI pains suggest:
- worse during eating
- better with eating
- just after eating
- a little more time after eating
Worse during eating: stomach problem
Better during eating: duodenum
Just after eating: reflux
A little more time after eating: problem further down in bowels
What might cause dysphagia with solids
Strictures from reflux or cancer
stuck in oesophagus
What might cause dysphagia with fluids
Neurological problem with musces
stuck in pharyngeus
What condition might the following symptoms indicate
- pain radiating to genitalia
- patient was dehydrated
Renal colic
Causes of hepatomegaly
- chronic liver disease
- cancer
- RHF
- blood disorders (lymphoma, leukaemia, myelofibrosis, polycythaemia)
Causes of splenomegaly
- blood disorders (myeloid leukaemia, myelofibrosis)
- portal hypertension
- infection (malaria)
- rheumatoid conditions: RA, SLE
Causes of hepatosplenomegaly
- lymphoma
- myeloproliferative disease
- cirrhosis
- portal hypertension
Which abdominal organs are retroperitoneal
SAD PUCKER
Suprarenal (adrenal) glands Aorta, IVC Duodenum Pancreas Ureteres Colon Kidneys Esophagus Rectum
Embryologically, which parts of the GI tract are the
- foregut
- midgut
- hindgut
Foregut: oesophagus -> 2nd part duodenum
Midgut: 2nd part duodenum -> proximal 2/3 transverse colon
Hindgut: Distal 1/3 transverse colon -> rectum
Describe the Grey Turners sign.
What is it a feature of?
Bruising of flanks (sign of retroperitoneal haemorrhage)
Indicates acute pancreatitis (leading to necrosis)
Describe the Cullens sign.
What is it a feature of?
Superficial oedema and bruising around umbilicus (in subcutaneous fatty tissue)
May indicate:
- acute pancreatitis
- ruptured AAA
- ruptured ectopic pregnancy
Causes of koilonychia
Iron deficiency anaemia
3 signs of peritonitis
- rebound tenderness
- percussion tenderness
- guarding
Which side do ileostomy and colostomy tend to appear on
Ileostomy: R side
Colostomy: L side
Where might pain from biliary colic radiate to?
Below R scapula
Describe Murphy’s sign
for cholecystitis
Push in RUQ, pain on inspiration disrupting breath
Describe Rovsing’s sign
for appendicitis
Push LIF but they feel pain in RIF
Describe McBurney’s point
for appendicitis
RIF pain
Over what age is renal colic rare
> 65
In patients >65 presenting with symptoms similar to renal colic, what must be excluded
AAA
What is the criteria for surgical repair of an AAA
> 5.5cm must be repaired
below 5.5cm, risks of surgery outweigh the benefits
Differentiating epigastric pain caused by GORD vs peptic ulcer disease
GORD pain would be worse when bending forward. Not so with PUD.
Lack of acid reflux makes PUD less likely
