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Short case clinical skills > Short case - Gastroenterology > Flashcards

Short case - Gastroenterology Flashcards

1
Q

Skin findings to look for

A

Pigmentation -Haemochromatosis, Addison’s disease
Freckle like spots on mouth, buccal mucosa fingers, toes - Peutz-Jeghers
Brown-black velvety elevations of epidermis on axillae and nape of neck - Acanthosis nigricans
Multiple small telangiectasia - Hereditary haemorrhagic telangiectasia
Petechiae
Scratch marks - bile cholestasis
Spider naevi
Campbell de Morgan spots

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2
Q

Gastro exam - hands

A 
Leukonychia - hypoalbuminaemia
Clubbing - cirrhosis
Palmar erythema - reddening of thenar and hypothenar eminences
Anaemia
Dupuytrens contracture
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3
Q

Differentials for palmar erythema

A 
Cirrhosis
Pregnancy
Thyrotoxicosis
Rheumatoid arthritis
polycythaemia
Chronic inflammatory states
Leukaemia
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4
Q

Differentials for spider naevi

A

Campbell de Morgan spots (non blanching)
Venous stars
Telangiectasia

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5
Q

Gastro - exam eyes

A 
Anaemia
Scleral icterus
Kayser-Fleischer rings of Wilson's disease
Xanthelesma of Biliary cirrhosis
Iritis of IBD
Periorbital purpura of amyloidosis
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6
Q

Gastro - mouth and face

A 
Parotid enlargement 
Faetor hepaticus
Ligua nigra tongue
Geographical tongue
Leukoplakia
Glossitis
Gum hypertrophy
Angular stomatitis
Aphthous ulceration
Candidiasis
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7
Q

Differentials for gum hypertrophy

A 
Phenytoin
Cyclosporin
Pregnancy
Gingivitis
Leukaemia
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8
Q

Differentials for pigmented lesions of mouth

A

Drugs - antimalarials, OCP - black/brown areas of tongue anywhere
Addison’s disease - blotches of dark brown pigment
Peutz-Jeghers
Malignant melanoma
Haemochromatosis -blue-grey pigmentation of hard palate
Lead, bismuth - lingula nigra

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9
Q

Differentials for bilateral parotid enlargement

A 
Alcohol associated parotitis
Severe dehydration
Malnutrition
Mumps
Sarcoidosis or lymphoma
Mikulicz syndrome - early sjogren's syndrome
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10
Q

Differentials for unilateral parotid enlargement

A

Salivary calculus blockage

Parotid tumour/tumour infiltration

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11
Q

General inspection of abdomen

A 
Distension
Surgical scars
Gynaecomastia
Prominent veins
Caput medusa
Sister Joseph nodule
Cullen's sign - discolouration of umbilicus
Grey turner sign - skin discoloration at flanks
Striae
Movement of abdomen and liver
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12
Q

Differentials for palpable liver

A

Hepatomegaly

Ptosis

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13
Q

Differentials for liver ptosis

A

Obstructive airways disease
Subdiaphragmatic collection
Riedel’s lobe

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14
Q

Differentials for massive hepatomegaly

A 
Metastasis
Alcoholic liver disease
Myeloproliferative disease
Right heart failure
Hepatocellular cancer
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15
Q

Differentials for mild hepatomegaly

A 
Metastasis
Alcoholic liver disease
Myeloproliferative disease
Other haematological disease - chronic leukaemia, lymphoma
Right heart failure
Hepatocellular cancer
Fatty liver
Hepatitis
Biliary obstruction
Hydatid disease
Haemachromatosis
Amyloidosis
Granulomatous infiltration
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16
Q

Differentials for tender liver

A 
Hepatitis
Right heart failure
Hepatic vein thrombosis (Budd Chiari syndrome)
Hepatic abscess
Biliary obstruction/cholangitis
17
Q

Differentials for pulsatile liver

A

Tricuspid regurgitation
Hepatocellular cancer
Vascular abnormalities

18
Q

Courvoisier’s law

A

If the patient is jaundiced and gallbladder palpable, it is unlikely to be gallstones
Consider pancreatic or lower biliary tree obstruction

19
Q

Differentials for gallbladder enlargement with jaundice

A

Carcinoma of head of pancreas
Carcinoma of ampulla of Vater
In situ gallstone formation in the CBD
Mucocele of the gallbladder due to stone in Hartman’s pouch and CBD

20
Q

Differentials for gallbladder enlargement without jaundice

A

Acute cholecystitis
Mucocele or empyema of gall bladder
Carcinoma of gall bladder

21
Q

Causes of hepatosplenomegaly

A

Chronic liver disease with portal hypertension
Haematological disease -MPD, leukaemia/lymphoma
Infection- viral hepatitis, CMV, EBV
Infiltration - amyloid, sarcoid
Connective tissue diseae - SLE
Acromegaly
Thyrotoxicosis

22
Q

Causes of unilateral palpable kidney

A 
Renal cell carcinoma
Hydronephrosis or pyonephrosis
Polycystic kidneys
Acute renal vein thrombosis
Acute pyelonephritis
Renal abscess
Single functioning kidney
23
Q

Causes of bilateral palpable kidney

A

Polycystic kidneys
Hydronephrosis or pyonephrosis bilaterally
Nephrotic syndrome, bilateral renal vein thrombosis
Acromegaly
Infiltrative disease - amyloid, lymphoma

24
Q

Most significant signs of ascites

A
  1. fluid wave
  2. Oedema
  3. Shifting dullness
25
Q

High Serum Ascites to Albumin Gradient

A 
Cirrhosis
Alcoholic hepatitis
Budd-Chiari syndrome or veno-occlusive disease
Fulminant hepatic failure
Congestive cardiac failure
Myxodema
26
Q

Low Serum Ascites to albumin gradient

A

Peritoneal analysis
Tuberculosis
Pancreatitis
Nephrotic Syndrome

27
Q

Cruveilhier-Baumgarten syndrome

A

Venous hum at the umbilicus due to dilated abdominal wall veins

28
Q

Causes of pre-sinusoidal portal hypertension

A

Portal vein compression (lymphoma etc)
Intravascular clotting (PCV)
Umbilcal vein phlebitis

29
Q

Causes of intrahepatic portal hypertension

A

Cirrhosis
Sarcoid, lymphoma or leukaemic infiltrates
Congenital hepatic fibrosis

30
Q

Causes of post-sinusoidal portal hypertension

A

Hepatic vein outflow obstruction/Budd chiari syndrome
Venoocclusive disease (acute GVHD)
CCF
Constrictive pericarditis

31
Q

Causes of hepatic vein outflow obstruction

A 
Myeloproliferative disease
Cancer (kidney pancreas, liver)
OCP
Trauma
Fibrous membrane
Schistosomiasis
Paroxysmal nocturnal dyspnoea
32
Q

Precipitants of encephalopathy

A 
Hypokalaemia - diarrhoea, diuretics, vomiting
Gastrointestinal bleeding
Infection
Constipation
Acute liver cell decompensation
Sedatives
Metabolic disturbances
Large protein load
33
Q

Signs of chronic liver disease in hands

A 
Palmar erythema
Leukonychia
Asterixis
Bruising
Scratch marks
clubbing
34
Q

Signs of chronic liver disease in face and chest

A 
Jaundice, scleral icterus
Fetor hepaticus
Spider naevi
Gynaecomastia
Loss of body hair
Bruising, scratch marks
Pectoral muscle wasting
35
Q

Signs of chronic liver disease in abdomen

A 
Ascites
Hepatomegaly
ascites 
Portal hypertension (splenomegaly, caput medusae, prominent abdominal veins)
Testicular atrophy
Oedema of legs
muscle wasting
Bruising and scratch marks
36
Q

Diagnosis of clinical cirrhosis

A

Two or more of:

  • Spider naevi
  • Palmar erythema
  • Splenomegaly or ascites
  • abdominal vein distension

Short case clinical skills (5 decks)

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