GIT Revision Flashcards
Looking for leukonychia in the hands on a GIT examination should be included. What is leukonychia?
- white lines or dots appear on your finger or toenails
- sign of liver disease
Looking for koilonychia in the hands on a GIT examination should be included. What is koilonychia?
- finger nails appear scooped up like a spoon
- common in iron deficiency
Looking for dupuytren’s contractures in the hands on a GIT examination should be included. What is dupuytren’s contractures?
- 1 or more fingers bend in towards your palm
- may be due to excessive alcohol
What is a stoma and what are the 2 types of stomas?
- an opening of the abdomen
- colostomy and ileostomy
Of the 9 areas of palpation on the abdomen, what are the top 3 from left to right?
- left hypochondriac
- epigastric
- left hypochondriac
Of the 9 areas of palpation on the abdomen, what are the middle 3 from left to right?
- left lumber
- umbilicus
- right lumbar
Of the 9 areas of palpation on the abdomen, what are the lower 3 from left to right?
- left inguinal
- hypogastric
- right inguinal
In the gastrointestinal examination we need to be able to look for an acute abdomen, what are the 3 things we need to look for?
1 - guarding
2 - rigidity
3 - rebound tenderness (pain when removing the hand)
What is splenomegaly and hepatomegaly?
- enlerged spleen and liver
In a normal healthy patient where would we expect to find the liver when feeling and percussing?
- upper border is 5th rib
- lower border is 10th rib
There are 2 signs of GIT disorders in the legs, one is called pyoderma gangrenosum, what is this?
- inflammatory skin disorder
- causes small, red bumps or blisters (papules or nodules) that eventually erode to form swollen open sores (ulcerations)
- can be caused by crohns disease
There are 2 signs of GIT disorders in the legs, one is called erythema nodosum, what is this?
- painful red nodules (or lesions) that most often develop on the arms or lower legs
- common in ulcerative colitis
How do we calculate BMI?
- weight (kg) / height (m)2
- me as an example: 80kg/1.86m2 = BMI of 23kgm2
According to NICE what are the cut offs for the different categories of BMI?
- healthy weight = BMI of 18.5-24.9 kg/m2
- overweight = BMI of 25-29.9 kg/m2
- obesity l = BMI of 30-34.9 kg/m2
- obesity ll = BMI of 35-39.9 kg/m2
- obesity lll = BMI of 40 kg/m2
What is the Malnutrition Universal Screening Tool (MUST) score used for?
- to determine if a patient is malnourished
- score of _>_2 means patients need treating
In order to create a Malnutrition Universal Screening Tool (MUST) score what is needed from the patient?
- BMI
- any unplanned weight loss (last 3-6 months)
- if patient is acutely ill
In order to create a Malnutrition Universal Screening Tool (MUST) score the patients BMI is needed, however, what can also be used to estimate BMI if normal BMI cannot be calculated?
- mid upper arm circumference
What is coeliac disease?
- autoimmune condition
- immune system attacks its own tissue when gluten is eaten
How common is coeliac disease?
- affects 1% of the population
What are the 3 main dietery components that commonly trigger coeliac disease?
- wheat, barley, rye and contaminated oats
Does coeliac disease affect the whole bowel?
- no
- small intestines only
What are the most common symptoms of coeliac disease?
- anaemia (B12, folate or iron)
- abdominal symptoms
- dermatitis herpetiformis (itchy blisters and raised red skin lesions)
To help diagnose patients with coeliac disease, you can screen them for antibodies. What antibodies can be screened for?
- anti tissue transglutaminase (TTG)
- anti-gliadin (main protein in gluten that causes the problem)
- anti-endomysial (connective tissue around smooth muscle in GIT)
When taking a biopsy from a patient with coeliac disease, which is the gold standard for diagnosis, what would we expect to see on biopsy?
- flattened villi in small intestines
- hyperplasia of crypts
- raised lymphocytes
What is the most effective treatment for coeliac disease?
- gluten free diet
Do patients with ceoliac disease, do they have blood in their stool?
- no
- diarrhoea
Ulcerative colitis (UC) if an inflammatory bowel disease. Does UC affect the whole GIT?
- no specific to colon
Ulcerative colitis (UC) if an inflammatory bowel disease. How does UC present when we look at tissue biopsies from the colon? Is the inflammatuion continous or is it patchy?
- continous inflammation with no gaps
Ulcerative colitis (UC) if an inflammatory bowel disease. How does UC present when we look at tissue biopsies from the colon? Does the inflammatuion affect all 4 layers of the GIT or just the top layers?
- only affects the mucosa
Ulcerative colitis (UC) if an inflammatory bowel disease. Is smoking a risk factor for UC?
- no
Ulcerative colitis (UC) if an inflammatory bowel disease. It generally begins in the rectum and works its way through the colon. What % of patients require surgery?
- 20-30%
Chrohns disease (CD) is an inflammatory bowel disease. Does CD affect the whole GIT?
- it can affect anywhere in the GIT
- mouth to anus
Chrons disease (CD) if an inflammatory bowel disease. How does CD present when we look at tissue biopsies from the colon? Is the inflammatuion continous or is it patchy?
- inflammation is patchy
Chrons disease (CD) if an inflammatory bowel disease. In addition to patchy inflammed areas, CD can cause other changes in the tissue, such as?
- fistulas = abnormal connection between 2 hollow tubes
- stricture = abnormal narrowing of GIT
- abscesses = collection of pus (inflammation, immune and dead cells)
- perianal disease = inflammed anal tissue
Crohns disease (CD) is an inflammatory bowel disease. How does DC present when we look at tissue biopsies from the colon? Does the inflammatuion affect all 4 layers of the GIT or just the top layers?
- transmural
- affects all 4 layers
In crohns disease are granulomas present?
- yes
- but non necrotising
In crohns disease associated with smoking?
- yes
What % of patients with crohns disease require surgery?
- 50%
In ulcerative colitis (UC) patients are at risk of perforation in an acute flair up of UC. Why is perforation in UC patients a medical emergancy?
- perforation is where mucosa is damaged and gas enters GIT wall
- this can expand and eventually rupture
- very dangerous
In ulcerative colitis (UC) patients are at risk of perforation in an acute flair up of UC. Perforation is where mucosa is damaged and gas enters the GIT wall, which can expand and eventually rupture. If a patient presents with this, how must they be treated?
- IV hydrocortisone
When treating chronic ulcerative colitis (UC) what is the order of treatments from: thiopurines, mesalazines and biologics?
1st = mesalazines
2nd = thiopurines
3rd = biologics
When treating chronic crohns disease what is the first treatment from thiopurines and biologics?
1st - thiopurines
2nd - biologics
What is Primary sclerosing cholangitis (PSC)?
- a chronic liver disease (suggested to be autoimmune)
- characterized by a progressive course of cholestasis )blockage of bile)
- causes inflammation and fibrosis of the intrahepatic and extrahepatic bile ducts
Why is Primary sclerosing cholangitis (PSC) important to consider in inflammatory bowel diseases?
- 80-90% of patients with PSC also have ulcerative colitis (UC)
- 5% of patients with UC have PSC
When doing an abdominal examination the acronym SOCRATES can be useful, what does it stand for?
- S = site of pain
- O = onset (when did it start)
- C = character (sharp/dull)
- R = radiates (e.g. loin to groin)
- A = associated symptoms
- T = time
- E = excentuate/relieve
- S = severity
Where are the 3 main areas of the abdomen we should consider?
1 - foregut
2 - midgut
3 - hindgut
When talking to a patient about diarrhoea, what chart should we use?
- bristol stool chart
When talking to a patient about diarrhoea, what should we ask about that might be present in the stool?
- blood
When talking to a patient about diarrhoea in addition to discussing the bristol stool chart and asking about the prescence of blood, what should we ask about?
- timings
- morning (IBS)
- evening
When a patient presents with diarrhoea what would be the most common differentials?
- infection
- IBS
- IBD (ulcerative colitis and crohns)
- coeliac disease
- colorectal cancer
- neuroendocrine tumour
- diverticulitis
If a patients presents with rectal bleeding, what should we ask the patient?
- colour
- mixed in with stool or on toilet paper
- if on toilet paper indicated rectal bleed (haemorrhoids)