GIT Flashcards
1
Q
DDx of hepatomegaly
A
Alcoholic liver disease Fatty liver Autoimmune hepatitis Hepatitis (A, B,C,D,E) Tropical Malaria Leukemia Lymphoma Schistosomiasis Leishmaniasis Hybrid cyst Amoebic abscess Polycysthemia Sickle cell anemia
2
Q
DDx of massive spleenomegaly
A
Infectious:
Hyper reactive malaria
Chronic tuberculosis
Sarcoidosis
Amyloidosis
Chronic schistosomiasis
Non- infectious:
leukemia
Non-Hodgkin lymphoma
Kala azar
Gaucher’s disease
Myelofibrosis
Tropical spleenomegaly ( idiopathic)
~~~
3
Q
DDx of moderate spleenomegaly
A
Tuberculosis Epstein Barr virus Hiv Sarcoidosis Leishmaniasis Schistosomiasis Endocarditis Lyme disease Leukemia Lymphoma
4
Q
Dupuytren’s contracture
A
- liver cirrhosis
- trauma especially for people who weed a lot
- epilepsy
- aging
- smoking
- alcohol use
- diabetes mellitus
- hiv
- lipoma
- fibroma
- neurofibromas
- tendon nodule
5
Q
Palmar erythema
A
Chronic liver disease Excess estrogen levels Pregnancy Kawasaki disease Systemic lupus erythema Tuberculosis Hiv Rheumatoid arthritis Diabetes mellitus Thyrotoxicosis Gestational syphyllis
6
Q
Gum hypertrophy
A
Chronic myeloid leukemia
7
Q
Apthous ulcers
A
Chron’s disease
Coelic disease
8
Q
Atrophic glossitis they have red beefy tongue
A
Vitamin B12 deficiency
Folate deficiency
Iron deficiency
9
Q
Clubbing in git
A
Liver cirrhosis
Hepatocellular carcinoma
Crohn’s disease
Ulcerative colitis
Coelic disease
Tropical sprue
Whipple disease
Malabsorption
GI lymphoma
Abdominal tb
10
Q
Spider naevi if greater than five significant
A
Chronic liver disease
Excess estrogen levels
11
Q
Angular stomatitis or angular Chelitis
A
Iron deficiency
Thiamine deficiency
Vitamin B12
Zinc deficiency
12
Q
Foetar hepaticus sweet smelling mouth of patient’s with liver cirrhosis
A
Due to portohepatic shunt
When blood from the intestine bypasses the liver and enters into other vessels which empty directly into the ivc
- ketoacidosis
- isopropyl alcohol poisoning
- late stage of hepatocellular failure and indicates hepatic encephalopathy
-
13
Q
Hepatic bruit
A
Hepatocellular carcinoma
14
Q
Aortic aneurysms
Aortic bruits
A
It is palpated by placing two fingers above the umbilicus
Atherosclerosis
Aneurysms
15
Q
Auscultation over renal arteries
Auscultation over veins
A
For renal bruits due to renal artery stenosis
Due to venous hums
16
Q
Scaphoid abdomen
A
- emancipated patient’s
- dehydration patient
- congenital diaphragmatic hernia
- carcinoma of the stomach and oesophagus
17
Q
Abscence or sparse pubic or axillary hair
A
Due to pituitary deficiency seen in old age
Hyperestrogenemia
18
Q
Stages and of hepatic encephalopathy
A
Stage 0: no personality or behavior abnormality detected and Asterexis is absent
Stage 1:trivial lack of attention, sleeping alternating patterns, euphoria, depression, shortened attention span, mildly confused
Stage 2: Asterexis is present, disorientation to time and place, inappropriate behavior, lethargy, apathy, personality change
Stage3: somnolent but arousable, slurred speech and confused
Stage 4: coma
19
Q
In obstructive jaundice
A
- scratch marks
- pale stools
- dark urine
20
Q
Hemochromatosis which is increased levels of iron in the blood causing skin pigmentation
A
- can lead to diabetes
- breathlessness in cvs
- joint pain in musculoskeletal
21
Q
DDx of spleenomegaly 17
A
Fever - infection (malaria, infective endocarditis, EBV, TB, CMV, HIV) - sarcoidosis, malignancy Lymphadenopathy - Leukemia - Lumphoma - Glandular fever With purapura - septicemia - amyloid - meningiococcemia With ascites - carcinoma - portal hypertension With ascites - carcinoma - portal hypertension With anemia - sickle cell anemia - thalassemia - pernicious anemia With weight - cancer - paraproteinemia
22
Q
DDx of hepatospleenomegaly 10
SL2IM
A
- infection: malaria, Infective endocarditis, hepatitis, Epstein Barr virus, Tuberculosis, HIV)
- malignancy
- leukemias
- Glandular fever
- Sickle cell
- Thalassemia
- Leishmaniasis
- paraproteinemia
- Gaucher’s syndrome
- amyloid
23
Q
Smooth hepatomegaly
Craggy hepatomegaly Secondaries or 1° hepatoma.
A
- Hepatitis,
- CCF,
- sarcoidosis,
- early alcoholic cirrhosis (a small liver is typical later)
- tricuspid incompetence (pulsatile liver) right heart failure
(Nodular cirrhosis typically causes a small, shrunken liver, not an enlarged craggy one.)
24
Q
Jaundice 20
A
Prehepatic/ haemolytic stage:
Erythrocyte defect: sickle cell anemia, thalassemia, lead poisoning
Excessive erythrocyte dysfunction: haemolytic anemia, thermal injury, breast milk jaundice, DIC, hemodialysis
Hepaticellular: Crigler-Najar, Gilbert’s disease, viral hepatitis, tuberculosis, autoimmune hepatitis, haemochromatosis, Wilson’s disease
Post hepatocellular: pregnancy, cystic liver disease, alcoholic liver disease, sepsis, Hodgkin’s lymphoma, primary or metatastic liver disease, Sarcoidosis, amyloidosis
25
Sickle cell anemia
- bossing of the frontal, parietal, occipital of the head
- gnathopathy
- arachynodactyl
- pain the hip joints
- scars at the medial malleolus
26
Xanthelasma
- chronic biliary disease
- primary biliary cirrhosis t
- hyperlipidemia
27
Kayser-Fleischer
Due to Wilson’s disease overload of copper
28
Gum hypertrophy
Acute myeloid leukemia
29
DDx of atrophic glossitis with red beefy tongue
- iron deficiency
- Vitamin B12 deficiency
- folate deficiency
30
Foetar hepaticus
| Has a mousy smell
Liver failure
31
Apthous ulcers
Crohn’s disease
| Celiac disease
32
Acanthois nigricans
- intrabdominal malignancies
- obesity
- diabetes
- cysts
- tumor
- cancer
33
Angular stomatitis
- thiamine deficiency
- Vitamin B12 deficiency
- iron deficiency
- zinc deficiency
34
Troiser’s sign at the left supraclavicular fossa
The enlarged node itself is called Virchow’s node, and can be caused by any abdominal or breast cancer, but is classic of gastric cancer.
35
Purapura
— hypersplenism
- impaired clotting function: haemophilia, malabsorption, poor diet, anticoagulant, disseminated intravascular coagulation
- Ehler’s Danlos , scurvy
36
Spider Naevi greater than five
| 6
- normal in children
- liver cirrhosis
- hypothyroidism
- rheumatoid arthritis
- pregnancy
- hyperestrogenemia
37
Gynaecomastia
| 10
- Chronic liver disease du to decreased oestrogen excretion
- Kinelfeter syndrome
- hypogonadism
- hyperprolactinemia
- hyperthyroidism
- spirinolactone
- metronidazole
- digoxin
- cimetidine
- breast cancer
38
DDx of striae or stretch marks
| 10
- rapid weight loss and gain
- past or current pregnancy
- Cushing syndrome
- ascites
- Marfan syndrome
- Ehler’s Danlos
- tuberculosis
- antiretroviral
- contraceptive
- chemotherapy
- steroids
39
Caput Medusa 5
| It is a classical sign of portal hypertension, causing distension of superficial veins surrounding the umbilicus
- cirrhosis
- right heart failure
- massive liver mestases
- fulminant liver failure
- portal venous thrombosis
40
Peritonitis : generalized abdominal tenderness
Generalised 'board-like' rigidity indicates peritonitis. In peritonitis, the abdomen also does not move during respiration and bowel sounds are absent.
Causes: blood, urine, bile, pancreatic fluid
41
Chronic peritonitis
The 'plastic abdomen' may also be detected and occurs with chronic peritonitis - eg, tuberculosis of the abdomen.
42
Guarding
Refers to the reflex tending of the abdominal muscles over the painful area which represents peritonitis
43
Rebound tenderness also known as blumberg sign
Refers to the initial pressure which does not cause pain but when the examining had is released, pain is felt. Rebound tenderness suggests peritoneal irritation
Causes: peritonitis or localized inflammation of peritoneum
44
DDx of Macroglossia
- myxoedema
- acromegaly
- amyloidosis
- massive infiltration with tumors
45
Omphalolith darkish substance on the umbilicus
- elderly people
| -
46
Paradoxical respiration
- normally the abdomen moves outward upon inspiration and inward upon expiration
- in paradoxical movement of the abdomen: the abdomen moves inward upon inspiration and outward upon expiration
DDx
- unilateral and bilateral paralysis of the diaphragm
- respiratory failure
- neuromuscular disease
47
Bowel sounds
- gurgling sounds: normal sound due movement of gas and fluid via peristalsis
- borborygmi sounds : normal sound due to movement of air in the gut. It is a loud and rumbling sound
- hypoactive or diminished sounds: peritonitis,proximal obstruction, ileus (inability of intestine to contract and move waste products out) and ischaemia
- hyperactive sounds: laxatives, gastroenteritis, inflammatory bowel disease (chron’s disease and ulcerative colitis),
48
Renal bruits
Renal artery stenosis
49
Signs of appendicitis
Tenderness felt over the McBurney point I.e a point located exactly one-thirdaway from the ASIS and the umbilicus
50
In RHF
The liver is enlarged, soft and tender
51
Murphy’s sign
Is done to detect cholecystitis
52
DDx of enlarged kidney
- polycystic kidney disease
- hydronephrosis
-
53
Striae/stretch marks
- rapid weight loss or gain
- pregnancy
- obesity
- Cushing syndrome
- ascites
- abdominal carcinoma
- steroid users
54
Enlarged veins
- emancipation
- portal hypertension
- inferior vena cava obstruction
55
Splenic bruit
To listen to the splenic friction rub at the site of splenic Infarct
56
Sister Mary Joseph
Umbilical nodule indicative of abdominal malignancy
57
In liver cirrhosis
The liver shrinks in size
| Hence liver span will be reduced
58
Yellowish teeth
- tetracycline
| - flucorosis
59
Ketosis
| Has a sweet smell
Diabetic ketoacidosis
| Extreme hunger
60
Uremia
| Fishy smell
End stage renal failure
61
Halitosis
| 2
- poor oral dentition
| - Zenker’s diverticulitis
62
Dryness of tongue
| 6
- dehydration
- diabetic ketoacidosis
- mouth breathing
- absence of salivary secretion: Sjögren syndrome and drugs (atropine)
63
Red beefy tongue
| 8
- iron deficiency
- folate deficiency
- vitamin b12 deficiency
- pernicious anemia
- malabsorption
- pellagra
- radiotherapy
- chemotherapy
64
Investigations for git dx
- computed tomography and magnetic resonance imaging
- x-rays
- ultrasonography
- laparoscopy
- endoscopy
- stool occult blood test
- paracentesis
65
Parotid swelling
- alcoholic liver disease
| - mumps
66
GIT causes of chest pain
- GERD, reflux or ulcers: retrosternal burning, precipitated by food or supine position ( night time), relieved by antacids not NTG
- oesophageal spasm: retrosternal chest pain, precipitated by meals, not exertional, may be relieved by NTG
- biliary folic: constant deep RUQ pain, rough on by fatty foods and exertion, not relieves by antacids or NTG
Peptic ulcer disease: epigastric ache or burn, after meals not exertional, gnawing pain at night, relieved by antacids not NTG
67
Oral hairy leukoplakia
Shaggy white patch on the side of the tongue seen in HIV
caused by EBV
68
Apthous ulcers
shallow, painful ulcers on the tongue or oral mucosa that heal without scarring.
Causes of severe ulcers: Crohn’s and coeliac disease; trauma; erythema multiforme; lichen planus; pemphigus; pemphigoid; infections (herpes simplex, syphilis, Vincent’s angina,
Minor ulcers: avoid oral trauma (eg hard toothbrushes or foods such as toast) and acidic foods or drinks. Tetracycline or antimicrobial mouth- washes (eg chlorhexidine) with topical steroids (eg triamcinolone gel) and topical analgesia.
Severe ulcers: possible therapies include systemic corticosteroids (eg oral prednisolone 30–60mg/d PO for a week) or thalidomide (absolutely contraindi- cated in pregnancy).
Biopsy any ulcer not healing after 3 weeks to exclude mal- ignancy; refer to an oral surgeon if uncertain.
69
Candidiasis/ oral thrush
Causes white patches or erythema of the buccal mu- cosa. Patches may be hard to remove and bleed if scraped.
Risk factors: Extremes of age; DM; antibiotics; immunosuppression (long-term corticosteroids, including in- halers; cytotoxics; malignancy; HIV).
RX: Nystatin suspension 400000U (4mL swill and swallow/6h). Fluconazole for oropharyngeal thrush.
70
Chelitis (angular stomatitis)
Fissuring of the mouth’s corners is caused by denture problems, candidiasis, or deficiency of iron or riboflavin (vitamin B2)
71
Gingivitis
Gum inflammation ± hypertrophy occurs with poor oral hygiene, drugs (phenytoin, ciclosporin, nifedipine), pregnancy, vitamin C deficiency (scurvy), acute myeloid leukaemia or Vincent’s angina
72
microstomia
The mouth is too small, eg from thickening and tightening of the perioral skin after burns or in epidermolysis bullosa (destructive skin and mucous membrane blisters ± ankyloglossia) or systemic sclerosis
73
Oral pigmentation
Perioral brown spots characterize Peutz–Jeghers’ )
. Pig- mentation anywhere in the mouth suggests Addison’s disease (p226) or drugs (eg antimalarials). Consider malignant melanoma. Telangiectasia: Systemic sclerosis; Osler–Weber–Rendu syndrome (p708). Fordyce glands: (Creamy yellow spots at the border of the oral mucosa and the lip vermilion.) Sebaceous cysts, common and benign. Aspergillus niger colonization may cause a black tongu
74
Teeth
A blue line at the gum–tooth margin suggests lead poisoning. Pre- natal or childhood tetracycline exposure causes a yellow–brown discolouration.
75
Tongue
This may be furred or dry (xerostomia) in dehydration, drug therapy, after radiotherapy, in Crohn’s disease,
76
Glossitis/ Macroglossia
- Means a smooth, red, sore tongue, eg caused by iron, folate, or B12 defi- ciency . If local loss of papillae leads to ulcer-like lesions that change in colour and size, use the term geographic tongue (harmless migratory glossitis).
Macroglossia: The tongue is too big. Causes: myxoedema; acromegaly; amyloid (p370).
77
White oral lesions
• Leucoplakia or hairy oral leukoplakia
• Lichen planus
• Poor dental hygiene
• Candidiasis
Lupus erythematosus
Smoking
• Squamous papilloma
Idiopathic keratosis
Carcinoma
• Aphthous stomatitis
• Secondary syphilis.
78
Upper GI endoscopy
Diagnostic
Haematemesis/melaena
Dysphagia
Dyspepsia (55yrs old and above + alarm symptoms or treatment refractory,
Duodenal biopsy (?coeliac)
Persistent vomiting
Stricture dilatation, polyp resection
Therapeutic
Treatment of bleeding lesions
Variceal banding and sclerotherapy
Stent insertion, laser therapy
Iron deficiency (cancer)
Complications: Sore throat; amnesia from sedation; perforation (<0.1%); bleeding (if on aspirin, clopidogrel, war- farin, or DOACS these need stopping only if therapeutic procedure).
Duodenal biopsy: The gold standard test for coeliac disease (p266); also useful in unusual causes of malabsorption, eg giardiasis, lymphoma, Whipple’s disease.
79
Sigmoidoscopy
Views the rectum + distal colon (to ~splenic flexure). Flexible sigmoidoscopy has largely displaced rigid sigmoidoscopy for diagnosis of distal colonic pathology, but ~25% of cancers are still out of reach. It can be used thera- peutically, eg for decompression of sigmoid volvulus
80
Colonoscopy
Diagnostic indications
Rectal bleeding—when settled, if acute
Iron-deficiency anaemia (bleeding cancer)
Persistent diarrhoea
Positive faecal occult blood test
Colon cancer surveillance
Therapeutic indications
Haemostasis (eg by clipping vessel)
Bleeding angiodysplasia lesion (argon beamer photocoagulation)
Colonic stent deployment (cancer)
Assessment or suspicion of IBD
Volvulus decompression (flexi sig)
Pseudo-obstruction Polypectomy
Complications: Abdominal discomfort; incom- plete examination; haemorrhage after biopsy or polypectomy; perforation (<0.1%). See figs 6.7–6.11. Post-procedure: no alcohol, and no operating machinery (car) for 24h.
81
Hemolytic uraemia syndrome
- a form of thrombotic microangiopathy
- usually seen in children under 5
typical HUS patient is a preschooler who has had a diarrheal illness for the past 5–10 days and presents with petechiae, jaundice, and oliguria.
Made up of a triad
Thrombocytopenia
Petechiae, purpura
Mucosal bleeding
Prolonged bleeding after minor cuts
Microangiopathic hemolytic anemia
Fatigue, dyspnea, and pallor
Jaundice
Impaired renal function
Hematuria, proteinuria
Oliguria, anuria
