the GI examination Flashcards
why is patient supine for GI examination
relaxes abdominal muscles
jaudice is caused by
hyperbilirubinaemia
telangiectasis
dilatation of capillaries causing them to appear as small red/purple clusters
hereditary hearrhagic telangiactasia
telangiectasis in nail beds, palms, feet
GI bleedings
pseudoxanthoma elasticum
yellow plagues/papules in flexural areas
bowel bleeding, ischaemia
blue rubber bleb syndrome
haemangiomas eg. on the tongue
bleeding into bowel or liver
inflammatory bowel disease
pyoderma gangrenosum eyrhtema nodosum clubbing mouth ulcers UC or chrons disease
haemochromatosis
bronze skin pigmentation
hepatomegaly, signss of chronic liver disease
diabetes, heart failure, arthropathy, testicular atrophy
systemic sclerosis
skin that it thick and bound down calcinosis raynauds phenomenon sclerodactyly telangiectases reflux, oesophageal dysmotility, small bowel bacterial overdose with malabrosption
skin pigmentation in haemochromatosis
haemosiderin stimulating melanocytes to produce melanin
addisonian type skin pigmantation
sun kissed pigmentation of the nipples, palmar creases, pressure areas and mouth
peutz-jeghers syndrome
freckle like spots (discrete brown lesons) around the mouth and on the buccal mucosa
assocated with hemartomas of the small bowel which may cause bleeding intussusception
incidence of GI adenocarcinoma is increased
acanthosis nigricans
brown to black velvety elevations of the epidermis due to confluent papillomas and are usually found in the axillae aand nape of the neck
associated rarely with GI carcinoma and lymphoma
associated with endocrinopathies
lauchonychia
chronc liver disease results in hyperbilirubinaemia causing the nail beds to opacify
clubbing in Gi exam
cirrhosis, inflammatory bowel disease, coeliac disease
palmar erythema
liver palms
affecting thenar and hypethenar eminences
soles of the feet may also be affected
anaemia
pallor of the palmar creases
may result from GI blood loss, malabsorbtion (folate, B12) haemolysis (hypersplenism), or chornic disease
dupuytren’s contracture
palpable thickening and contraction of the palmar fascia causing permentn flecion
associated with alcoholism, found in manual workers, familial
hepatic flap
asterixis
hepatic encephalopathy
absent at rest and brought on by sustained posture
can also occur in cardiac, respiratory and renal failure as well as hypoglycaemia, hypokalaemia, hypomagnesaemia or barbturate intoxication
2 reasons for brusing
hepatocellular damage can interfere with protein synthesis for the production of clotting factors
obstructive jaundice results in a shortage of bile acids and reduced absorbtion of vit K which is vtal for the production of some clotting factors
3 causes of petechiae
chronic excessive alcohol consumption causes bone marrow depletion causing thrombocytopenia
spenomegaly secondary to portal hypertension can cause hypersplenism resulting in excessive destruction of platelets in the spleen
in severe liver disease - DIC can occur
scratch marks
due to severe itch
are often prominent in pateints with obstructive or cholestatic jaundice
commonly resenting feature in primary biliary cholaangitis
spider naevi are found on
the areas usually drained by the superior vena cava
found on arms, neck and chest wall
characteristic of spider naevi
occassionally bleed
presssure applied to the central arteriolle will cause blanching of the whole lesion
rapid reflling occurs on release of pressure
causes of spider naevi
cirrhosis, frequently due to alcohol
if a spider naevi does blanch
campbell de morgan spots - elevated and no dot blanch, common and benign
venous stars - 2-3cm lesions, not blanched
hereditary haemorrhagic telangiectasia - resemble spider naevi
bitot’s spots
yellow keratinised areas on the sclera
severe vit A deficiency
retinal damage and blindness may ensue
kayser-fleischer rings
brownish green rings occuring at the periphery of the cornea, affecting the upper pole more thnaa the lower
typically found in wilson’s diseaase
wilson’s disease
copper storage disease that causes cirrhosiis and neurological disturbances
kayser fleischer rings are usually present by the time neurological signs have appeared
xanthalasmata
yellowish plaques in the subcutaneous tissues in the periorbital region and are due to deposits of lipids
elevation of serum cholesterol
common in patients with primary biliary cirrhosis
in patinets with cholestasis, lipoprotein X in found in the plasma and is associated with elevation of serum cholesterol
bilateral parotidomegaly
associated with alcoholism
due to fatty infiltration
may be mumps
causes of fetor
- faulty oral hygiene
- fetor hepaticus (a sweet smell)
- ketosis (diabetic ketoacidosis results in excretion of ketones in exhaled air, causing a sickly sweet smell)
- uraemia (fish breath: an ammoniacal odour)
- alcohol
- paraldehyde
- putrid ( due to anaerobic chest infection with large amount of sputum)
- cigarettes
lingua nigra
black tongue due to accumulation of kerratin due to elongation of papillae over the posterior part of the tongue
symptomless
geographical tongue
slowly changing red rings and lones that occur over the surface of the tongue
not painful
leukoplakia
white coloured thickening of the mucosa
premalignant
may be caused by sore teeth, smoking, spirits, sepsis orr syphilis
glossitis
smooth appearance of the tongue due to atrophy of the papillae may be shollow ulceration due to nutritional deficiency common in alcoholics
macroglossia
may occur in congenital conditions such as downs syndrome or in endocrine disease, including acromegaly
tumour infiltration or infiltration of the tongue with amyloid mateiral my be responsible
aphthous ulceration
painful shallow ulcer
may occur in chrons or ulcerative colitis
angular stomatitis
refers. to cracks at the corners of the mouth
vitamin deficiency
gynaecomastia
may be unilateral or bilateral and the breasts may be tender
may be a sign of chronic liver disease
may be alcoholic cirrhosis or chronic autoimmune hepatitis
patents with severe portal hypertension
portal to systemic flow occurss through the umbilical veins, which may become engorged and distended
called caput medusae
striae
pink linear marks with wrinkled appearance
stretching of the abdominal wall severe enough to cause rupture of the elastic fibres in the skin
usually pregnancy, recent weight gain
may be cushings syndrome
features of intraabdominal masses
region involved tenderness size surface, regular or irregular edge consistancy - hard or soft mobility and movement with inspiraation whether it is pulsitile or not whethher one can get above the mass
rigidity of the abdominal muscles
involuntry reflex (unlike guarding) tenderness and indicated peritoneal irritation or inflammation
rebound tenderness
strongly suggests perintonitis
how to feel for hepatomegaly
more your hand during expiration
wait during inspiration for the liver to come into contact
describing the liver edge
hard or soft, tender or non tender, regular or irregular, pulsitile or non ppulsitile
normal liver span in
<13cm
massive hepatomegaly likely due to
right heart failure metastasis alcholic liver disease with fatty infiltration myeoloproliferative disease hepatocellular cancer
moderate enlarged liver likely due to
haemochromatosis
heamatological disease
fatty liver
infiltration
mild hepatomegaly likely due to
hepatitis
biliary obstruction
hydatid disease
HIv infection
firm and irregular liver likely due to
hepatocellular carcinoma
metastatic disease
cirrhosis
hydatid disease, grauloma, amyloid, cystsk lipoidoses
tender liver causes
hepatitis rapid liver enlargement syndrome hepatocellular cancer hepatic abscess biliary obstruction cholangitis
pulsitile liver
tricuspid regurgitation
hepatocellular cancer
vascular abnormalitlies
causes of hepatosplenomegaly
chronic liver disease with portal hypertension haematologicla disease infection infiltration connective tissue disease acromegaly thyrotoxicosis
types of infections causes hepatospenomegaly
acute viral hepatitis, infections mononucleiosus, cytomeglovirus
kidneys with inspiration
move downward on inspiration
