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Internal medicoine > GIT > Flashcards

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
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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)

~~~

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3
Q

DDx of moderate spleenomegaly

A 
Tuberculosis
Epstein Barr virus
Hiv
Sarcoidosis
Leishmaniasis
Schistosomiasis
Endocarditis
Lyme disease
Leukemia 
Lymphoma
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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
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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
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6
Q

Gum hypertrophy

A

Chronic myeloid leukemia

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7
Q

Apthous ulcers

A

Chron’s disease

Coelic disease

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8
Q

Atrophic glossitis they have red beefy tongue

A

Vitamin B12 deficiency
Folate deficiency
Iron deficiency

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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

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10
Q

Spider naevi if greater than five significant

A

Chronic liver disease

Excess estrogen levels

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11
Q

Angular stomatitis or angular Chelitis

A

Iron deficiency
Thiamine deficiency
Vitamin B12
Zinc deficiency

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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
-

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13
Q

Hepatic bruit

A

Hepatocellular carcinoma

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14
Q

Aortic aneurysms

Aortic bruits

A

It is palpated by placing two fingers above the umbilicus

Atherosclerosis
Aneurysms

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15
Q

Auscultation over renal arteries

Auscultation over veins

A

For renal bruits due to renal artery stenosis

Due to venous hums

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16
Q

Scaphoid abdomen

A
  • emancipated patient’s
  • dehydration patient
  • congenital diaphragmatic hernia
  • carcinoma of the stomach and oesophagus
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17
Q

Abscence or sparse pubic or axillary hair

A

Due to pituitary deficiency seen in old age

Hyperestrogenemia

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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

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19
Q

In obstructive jaundice

A
  • scratch marks
  • pale stools
  • dark urine
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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
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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
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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
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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.)

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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

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25
Q

Sickle cell anemia

A
  • bossing of the frontal, parietal, occipital of the head
  • gnathopathy
  • arachynodactyl
  • pain the hip joints
  • scars at the medial malleolus
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26
Q

Xanthelasma

A
  • chronic biliary disease
  • primary biliary cirrhosis t
  • hyperlipidemia
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27
Q

Kayser-Fleischer

A

Due to Wilson’s disease overload of copper

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28
Q

Gum hypertrophy

A

Acute myeloid leukemia

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29
Q

DDx of atrophic glossitis with red beefy tongue

A
  • iron deficiency
  • Vitamin B12 deficiency
  • folate deficiency
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30
Q

Foetar hepaticus

Has a mousy smell

A

Liver failure

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31
Q

Apthous ulcers

A

Crohn’s disease

Celiac disease

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32
Q

Acanthois nigricans

A
  • intrabdominal malignancies
  • obesity
  • diabetes
  • cysts
  • tumor
  • cancer
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33
Q

Angular stomatitis

A
  • thiamine deficiency
  • Vitamin B12 deficiency
  • iron deficiency
  • zinc deficiency
34
Q

Troiser’s sign at the left supraclavicular fossa

A

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
Q

Purapura

A

— hypersplenism

  • impaired clotting function: haemophilia, malabsorption, poor diet, anticoagulant, disseminated intravascular coagulation
  • Ehler’s Danlos , scurvy
36
Q

Spider Naevi greater than five

6

A
  • normal in children
  • liver cirrhosis
  • hypothyroidism
  • rheumatoid arthritis
  • pregnancy
  • hyperestrogenemia
37
Q

Gynaecomastia

10

A
  • Chronic liver disease du to decreased oestrogen excretion
  • Kinelfeter syndrome
  • hypogonadism
  • hyperprolactinemia
  • hyperthyroidism
  • spirinolactone
  • metronidazole
  • digoxin
  • cimetidine
  • breast cancer
38
Q

DDx of striae or stretch marks

10

A
  • rapid weight loss and gain
  • past or current pregnancy
  • Cushing syndrome
  • ascites
  • Marfan syndrome
  • Ehler’s Danlos
  • tuberculosis
  • antiretroviral
  • contraceptive
  • chemotherapy
  • steroids
39
Q

Caput Medusa 5

It is a classical sign of portal hypertension, causing distension of superficial veins surrounding the umbilicus

A
  • cirrhosis
  • right heart failure
  • massive liver mestases
  • fulminant liver failure
  • portal venous thrombosis
40
Q

Peritonitis : generalized abdominal tenderness

A

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
Q

Chronic peritonitis

A

The ‘plastic abdomen’ may also be detected and occurs with chronic peritonitis - eg, tuberculosis of the abdomen.

42
Q

Guarding

A

Refers to the reflex tending of the abdominal muscles over the painful area which represents peritonitis

43
Q

Rebound tenderness also known as blumberg sign

A

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
Q

DDx of Macroglossia

A
  • myxoedema
  • acromegaly
  • amyloidosis
  • massive infiltration with tumors
45
Q

Omphalolith darkish substance on the umbilicus

A
  • elderly people

-

46
Q

Paradoxical respiration

A
  • 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
Q

Bowel sounds

A
  • 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
Q

Renal bruits

A

Renal artery stenosis

49
Q

Signs of appendicitis

A

Tenderness felt over the McBurney point I.e a point located exactly one-thirdaway from the ASIS and the umbilicus

50
Q

In RHF

A

The liver is enlarged, soft and tender

51
Q

Murphy’s sign

A

Is done to detect cholecystitis

52
Q

DDx of enlarged kidney

A
  • polycystic kidney disease
  • ## hydronephrosis
53
Q

Striae/stretch marks

A
  • rapid weight loss or gain
  • pregnancy
  • obesity
  • Cushing syndrome
  • ascites
  • abdominal carcinoma
  • steroid users
54
Q

Enlarged veins

A
  • emancipation
  • portal hypertension
  • inferior vena cava obstruction
55
Q

Splenic bruit

A

To listen to the splenic friction rub at the site of splenic Infarct

56
Q

Sister Mary Joseph

A

Umbilical nodule indicative of abdominal malignancy

57
Q

In liver cirrhosis

A

The liver shrinks in size

Hence liver span will be reduced

58
Q

Yellowish teeth

A
  • tetracycline

- flucorosis

59
Q

Ketosis

Has a sweet smell

A

Diabetic ketoacidosis

Extreme hunger

60
Q

Uremia

Fishy smell

A

End stage renal failure

61
Q

Halitosis

2

A
  • poor oral dentition

- Zenker’s diverticulitis

62
Q

Dryness of tongue

6

A
  • dehydration
  • diabetic ketoacidosis
  • mouth breathing
  • absence of salivary secretion: Sjögren syndrome and drugs (atropine)
63
Q

Red beefy tongue

8

A
  • iron deficiency
  • folate deficiency
  • vitamin b12 deficiency
  • pernicious anemia
  • malabsorption
  • pellagra
  • radiotherapy
  • chemotherapy
64
Q

Investigations for git dx

A
  • computed tomography and magnetic resonance imaging
  • x-rays
  • ultrasonography
  • laparoscopy
  • endoscopy
  • stool occult blood test
  • paracentesis
65
Q

Parotid swelling

A
  • alcoholic liver disease

- mumps

66
Q

GIT causes of chest pain

A
  • 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
Q

Oral hairy leukoplakia

A

Shaggy white patch on the side of the tongue seen in HIV
caused by EBV

68
Q

Apthous ulcers

A

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
Q

Candidiasis/ oral thrush

A

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
Q

Chelitis (angular stomatitis)

A

Fissuring of the mouth’s corners is caused by denture problems, candidiasis, or deficiency of iron or riboflavin (vitamin B2)

71
Q

Gingivitis

A

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
Q

microstomia

A

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
Q

Oral pigmentation

A

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
Q

Teeth

A

A blue line at the gum–tooth margin suggests lead poisoning. Pre- natal or childhood tetracycline exposure causes a yellow–brown discolouration.

75
Q

Tongue

A

This may be furred or dry (xerostomia) in dehydration, drug therapy, after radiotherapy, in Crohn’s disease,

76
Q

Glossitis/ Macroglossia

A
  • 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
Q

White oral lesions

A

• Leucoplakia or hairy oral leukoplakia
• Lichen planus
• Poor dental hygiene
• Candidiasis
Lupus erythematosus
Smoking
• Squamous papilloma
Idiopathic keratosis
Carcinoma
• Aphthous stomatitis
• Secondary syphilis.

78
Q

Upper GI endoscopy

A

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
Q

Sigmoidoscopy

A

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
Q

Colonoscopy

A

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
Q

Hemolytic uraemia syndrome

A
  • 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

Internal medicoine (10 decks)

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