GIT Flashcards
A 42 year old man presents to A&E with diffuse abdominal pain. He has had indigestion for the last 6 weeks. He looked ill, pale clammy and in extreme discomfort. Examination of the abdomen is limited because of pain and the board-like rigidity of it.
Choose the diagnosis that match the following clinical scenarios.
- Heartburn
- Biliary colic
- Renal colic
- Pancreatitis
- Peritonitis
- Intestinal obstruction
- Peptic ulcer
- Appendicitis
- Diverticulitis
- Irritable bowel syndrome
- Acute pyelonephritis
- Urinary tract infection
- Diabetic ketoacidosis
-Peritonitis
This man is extremely ill and is a surgical emergency. Severe pain and board like rigidity points to peritonitis
A 72 year old woman who had a right hemicolectomy 8 years ago presents to A&E with colicky pains coming on in intermittent waves. She has vomited foul smelling brown liquid several times. Her abdomen had swelled in size and is very resonant to percussion. She has not had her bowels open for 3 days.
Choose the diagnosis that match the following clinical scenarios.
- Heartburn
- Biliary colic
- Renal colic
- Pancreatitis
- Peritonitis
- Intestinal obstruction
- Peptic ulcer
- Appendicitis
- Diverticulitis
- Irritable bowel syndrome
- Acute pyelonephritis
- Urinary tract infection
- Diabetic ketoacidosis
-Intestinal obstruction
True colicky pain is a marker of obstruction. Foul smelling brown liquid suggests faeculent fluid and the obstruction is likely to be intestinal. Further evidence of a ‘blockage’ is the swelling of the abdomen which will distend proximal to the obstruction. The final clue is that she has not had her bowels opened and this may be absolute constipation when even flatus cannot be passed. As she has had a previous operation the likelihood is that she has adhesions around the previous operation site that is causing obstruction of the bowel
A 68 year old man has suffered chronic urinary frequency for over a year. Over the last 2 days he has suffered bouts of severe right loin pain radiating to his groin. He has been off his food and felt nauseous, urinalysis shows blood+++ and protein++
Choose the diagnosis that match the following clinical scenarios.
- Heartburn
- Biliary colic
- Renal colic
- Pancreatitis
- Peritonitis
- Intestinal obstruction
- Peptic ulcer
- Appendicitis
- Diverticulitis
- Irritable bowel syndrome
- Acute pyelonephritis
- Urinary tract infection
- Diabetic ketoacidosis
-Renal colic
The pain this man has experienced is typical of renal colic. The pain can be severe and lead to nausea, anorexia and sweating. Blood in the urine will be typical and an ultrasound will be useful in identifying any renal stones.
A 52 year old man who is a chief executive of a local hospital trust presents to his GP with a burning pain that radiates up his sternum and into the rest of his neck. He found milk of magnesia and gaviscon relieved the pain at first but now they are only partially effective. He has found hot tea aggravates the pain
Choose the diagnosis that match the following clinical scenarios.
- Heartburn
- Biliary colic
- Renal colic
- Pancreatitis
- Peritonitis
- Intestinal obstruction
- Peptic ulcer
- Appendicitis
- Diverticulitis
- Irritable bowel syndrome
- Acute pyelonephritis
- Urinary tract infection
- Diabetic ketoacidosis
-Heartburn
The pain described is classical of heartburn with retrosternal pain radiating up to the neck. The fact that antacids are becoming less effective suggests that his pathology is advancing. Hot tea is known to aggravate oesophagitis. It may also be possible that he could be developing a peptic ulcer. The other condition to consider that can mimic indigestion/heartburn is myocardial ischaemia and a middle aged man should also be investigated for possible coronary artery disease.
A semi-conscious 24 year old is admitted to the medical admissions unit. He had been complaining of vague central abdomen pain. He has been thirsty and has had urinary frequency and nocturia up to 3-4x per night. He has had no dysuria. For the last 2 months he has lost 6 kg in weight. His urine dipstick shows protein+, a trace of blood, glucose+++, Ketones+++
Choose the diagnosis that match the following clinical scenarios.
- Heartburn
- Biliary colic
- Renal colic
- Pancreatitis
- Peritonitis
- Intestinal obstruction
- Peptic ulcer
- Appendicitis
- Diverticulitis
- Irritable bowel syndrome
- Acute pyelonephritis
- Urinary tract infection
- Diabetic ketoacidosis
-Diabetic ketoacidosis
This is an unusual presentation for diabetic ketoacidosis but does occur. The clues are found in the other systems ie thirst, urinary frequency and weight loss. The diagnosis is even trickier if the patient is not known to be a diabetic. The clues are in the urinalysis with glucose and ketones.
You perform a rectal examination on an 85 year old woman who was admitted with constipation. Inspection of the anus was unremarkable. Following digital insertion a large mass is found protruding into the lumen. By pushing gently upwards the finger indents the mass. Following withdrawal of the finger, a small residue of brown faecal matter is observed on the glove.
Which option best represents your clinical findings?
- Perianal warts
- Anal fissure
- Faecal loading
- Benign prostatic hypertrophy
- Prostatic carcinoma
- Skin tags
- Rectal carcinoma
- Squamous cell carcinoma of the anus
- Thrombosed haemorrhoid
- Rectal prolapse
-Faecal loading
This mass could easily be mistaken for a rectal tumour but this indentation helps to identify this as a faecal mass
You perform a rectal examination on a forty two year old man with intermittent rectal bleeding. He describes bright red streaking of blood on his stool and he tends towards constipation. As you attempt digital insertion he shouts in pain and you have to abandon the examination.
Which option best represents your clinical findings?
- Perianal warts
- Anal fissure
- Faecal loading
- Benign prostatic hypertrophy
- Prostatic carcinoma
- Skin tags
- Rectal carcinoma
- Squamous cell carcinoma of the anus
- Thrombosed haemorrhoid
- Rectal prolapse
-Anal fissure
The pain is highly suggestive of an anal fissure. It is likely that he has passed very hard stools with his constipation which has damaged the mucosa of the anal canal. This leads to intermittent bleeding and discomfort on defaecation
You perform a rectal examination on a 70 year old man with mild lower abdominal pain. As you rotate your finger anteriorly you note that the prostate is larger than normal with a rubbery consistency. You are able to appreciate both lateral lobes and the median sulcus.
Which option best represents your clinical findings?
- Perianal warts
- Anal fissure
- Faecal loading
- Benign prostatic hypertrophy
- Prostatic carcinoma
- Skin tags
- Rectal carcinoma
- Squamous cell carcinoma of the anus
- Thrombosed haemorrhoid
- Rectal prolapse
-Benign prostatic hypertrophy
This is a good description of prostatic enlargement as palpated per rectum. This may be an incidental finding while investigating his abdominal pain or he may have cystitis or other bladder conditions that could be related to poor urine outflow.
You examine a 69 year old woman who presents with altered bowel habit and faecal incontinence. You perform a rectal examination and feel a hard craggy mass posteriorly that does not indent. When you withdraw your finger there is blood dark red blood on your finger.
Which option best represents your clinical findings?
- Perianal warts
- Anal fissure
- Faecal loading
- Benign prostatic hypertrophy
- Prostatic carcinoma
- Skin tags
- Rectal carcinoma
- Squamous cell carcinoma of the anus
- Thrombosed haemorrhoid
- Rectal prolapse
-Rectal carcinoma
This has all the hallmarks of a rectal tumour. She will need the rest of her bowel investigated to make sure that she has not got lesions elsewhere.
A 79 year old man is being assessed for obstructive urinary symptoms. He has hesitancy, a poor stream and terminal dribbling. A rectal examination demonstrates a hard swelling in the prostate gland. In addition the median sulcus cannot be indentified.
Which option best represents your clinical findings?
- Perianal warts
- Anal fissure
- Faecal loading
- Benign prostatic hypertrophy
- Prostatic carcinoma
- Skin tags
- Rectal carcinoma
- Squamous cell carcinoma of the anus
- Thrombosed haemorrhoid
- Rectal prolapse
-Prostatic carcinoma
This patient has all the hallmarks of obstructive urinary symptoms that have been outlined above. However the finding of a hard swelling together with the loss of the median sulcus strongly suggests a prostatic cancer.
