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examinations > the GI examination > Flashcards

the GI examination Flashcards

1
Q

why is patient supine for GI examination

A

relaxes abdominal muscles

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2
Q

jaudice is caused by

A

hyperbilirubinaemia

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3
Q

telangiectasis

A

dilatation of capillaries causing them to appear as small red/purple clusters

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4
Q

hereditary hearrhagic telangiactasia

A

telangiectasis in nail beds, palms, feet

GI bleedings

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5
Q

pseudoxanthoma elasticum

A

yellow plagues/papules in flexural areas

bowel bleeding, ischaemia

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6
Q

blue rubber bleb syndrome

A

haemangiomas eg. on the tongue

bleeding into bowel or liver

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7
Q

inflammatory bowel disease

A 
pyoderma gangrenosum 
eyrhtema nodosum 
clubbing 
mouth ulcers 
UC or chrons disease
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8
Q

haemochromatosis

A

bronze skin pigmentation
hepatomegaly, signss of chronic liver disease
diabetes, heart failure, arthropathy, testicular atrophy

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9
Q

systemic sclerosis

A 
skin that it thick and bound down 
calcinosis 
raynauds phenomenon 
sclerodactyly 
telangiectases 
reflux, oesophageal dysmotility, small bowel bacterial overdose with malabrosption
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10
Q

skin pigmentation in haemochromatosis

A

haemosiderin stimulating melanocytes to produce melanin

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11
Q

addisonian type skin pigmantation

A

sun kissed pigmentation of the nipples, palmar creases, pressure areas and mouth

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12
Q

peutz-jeghers syndrome

A

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

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13
Q

acanthosis nigricans

A

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

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14
Q

lauchonychia

A

chronc liver disease results in hyperbilirubinaemia causing the nail beds to opacify

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15
Q

clubbing in Gi exam

A

cirrhosis, inflammatory bowel disease, coeliac disease

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16
Q

palmar erythema

A

liver palms
affecting thenar and hypethenar eminences
soles of the feet may also be affected

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17
Q

anaemia

A

pallor of the palmar creases

may result from GI blood loss, malabsorbtion (folate, B12) haemolysis (hypersplenism), or chornic disease

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18
Q

dupuytren’s contracture

A

palpable thickening and contraction of the palmar fascia causing permentn flecion
associated with alcoholism, found in manual workers, familial

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19
Q

hepatic flap

A

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

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20
Q

2 reasons for brusing

A

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

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21
Q

3 causes of petechiae

A

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

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22
Q

scratch marks

A

due to severe itch
are often prominent in pateints with obstructive or cholestatic jaundice
commonly resenting feature in primary biliary cholaangitis

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23
Q

spider naevi are found on

A

the areas usually drained by the superior vena cava

found on arms, neck and chest wall

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24
Q

characteristic of spider naevi

A

occassionally bleed
presssure applied to the central arteriolle will cause blanching of the whole lesion
rapid reflling occurs on release of pressure

25
Q

causes of spider naevi

A

cirrhosis, frequently due to alcohol

26
Q

if a spider naevi does blanch

A

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

27
Q

bitot’s spots

A

yellow keratinised areas on the sclera
severe vit A deficiency
retinal damage and blindness may ensue

28
Q

kayser-fleischer rings

A

brownish green rings occuring at the periphery of the cornea, affecting the upper pole more thnaa the lower
typically found in wilson’s diseaase

29
Q

wilson’s disease

A

copper storage disease that causes cirrhosiis and neurological disturbances
kayser fleischer rings are usually present by the time neurological signs have appeared

30
Q

xanthalasmata

A

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

31
Q

bilateral parotidomegaly

A

associated with alcoholism
due to fatty infiltration
may be mumps

32
Q

causes of fetor

A
  • 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
33
Q

lingua nigra

A

black tongue due to accumulation of kerratin due to elongation of papillae over the posterior part of the tongue
symptomless

34
Q

geographical tongue

A

slowly changing red rings and lones that occur over the surface of the tongue
not painful

35
Q

leukoplakia

A

white coloured thickening of the mucosa
premalignant
may be caused by sore teeth, smoking, spirits, sepsis orr syphilis

36
Q

glossitis

A 
smooth appearance of the tongue 
due to atrophy of the papillae 
may be shollow ulceration 
due to nutritional deficiency 
common in alcoholics
37
Q

macroglossia

A

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

38
Q

aphthous ulceration

A

painful shallow ulcer

may occur in chrons or ulcerative colitis

39
Q

angular stomatitis

A

refers. to cracks at the corners of the mouth

vitamin deficiency

40
Q

gynaecomastia

A

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

41
Q

patents with severe portal hypertension

A

portal to systemic flow occurss through the umbilical veins, which may become engorged and distended
called caput medusae

42
Q

striae

A

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

43
Q
A
44
Q

features of intraabdominal masses

A 
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
45
Q

rigidity of the abdominal muscles

A 
involuntry reflex (unlike guarding) 
tenderness and indicated peritoneal irritation or inflammation
46
Q

rebound tenderness

A

strongly suggests perintonitis

47
Q

how to feel for hepatomegaly

A

more your hand during expiration

wait during inspiration for the liver to come into contact

48
Q

describing the liver edge

A

hard or soft, tender or non tender, regular or irregular, pulsitile or non ppulsitile

49
Q

normal liver span in

A

<13cm

50
Q

massive hepatomegaly likely due to

A 
right heart failure 
metastasis 
alcholic liver disease with fatty infiltration 
myeoloproliferative disease 
hepatocellular cancer
51
Q

moderate enlarged liver likely due to

A

haemochromatosis
heamatological disease
fatty liver
infiltration

52
Q

mild hepatomegaly likely due to

A

hepatitis
biliary obstruction
hydatid disease
HIv infection

53
Q

firm and irregular liver likely due to

A

hepatocellular carcinoma
metastatic disease
cirrhosis
hydatid disease, grauloma, amyloid, cystsk lipoidoses

54
Q

tender liver causes

A 
hepatitis 
rapid liver enlargement syndrome 
hepatocellular cancer 
hepatic abscess 
biliary obstruction cholangitis
55
Q

pulsitile liver

A

tricuspid regurgitation
hepatocellular cancer
vascular abnormalitlies

56
Q

causes of hepatosplenomegaly

A 
chronic liver disease with portal hypertension 
haematologicla disease 
infection 
infiltration 
connective tissue disease 
acromegaly 
thyrotoxicosis
57
Q

types of infections causes hepatospenomegaly

A

acute viral hepatitis, infections mononucleiosus, cytomeglovirus

58
Q

kidneys with inspiration

A

move downward on inspiration

examinations (6 decks)

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