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GI examination > Common GI Symptoms > Flashcards

Common GI Symptoms Flashcards

1
Q

Anorexia

A

Loss of appetite

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2
Q

Significant weight loss

A

> 3kg in 6 months

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3
Q

Significant weight loss and amenorrhoea

A

Suggest anorexia nervosa

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4
Q

Apthous ulcers

A

Suggested by a history of recurrent painful ulcers, onset as menarche, exacerbations during menstruation and family history of mouth ulcers

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5
Q

Pain within the mouth.

A

Associated with; Iron or Vitamin B12 deficiency, dermatological disorders (lichen planus, chemotherapy, aphthous ulcers, infective stomatitis), Inflammatory bowel disease

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6
Q

Dysphagia

A

Difficulty swallowing

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7
Q

Early satiety

A

Premature fullness

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8
Q

Globus

A

Feeling of a lump in ones throat

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9
Q

Odynophagia

A

Pain upon swallowing, often precipitated by drinking hot liquids

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10
Q

Odynophagia without dysphagia is suggestive of?

A
  • Active oesophageal ulceration from peptic oesophagitis

- Oesophageal candidiasis

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11
Q

Neurological dysphagia.

A
  • Difficulty swallowing due to bulbar or pseudo bulbar pulsies. It is typically worse with liquids.
  • Cerebrovascular incident
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12
Q

Oral causes of dysphagia?

A
  • Painful mouth ulcers

- Tonsilitis, glandular five, pharyngitis, peritonsillar abscess

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13
Q

Neuromuscular causes of dysphagia?

A
  • Achalasia (Failure od smooth muscle to relax in lower oesophagus)
  • Pharyngeal pouch (Zenker’s diverticulum, weakness in the muscles of the pharynx = ballooning outwards of oesophagus)
  • Myasthenia gravis (Muscle weakness)
  • Oesophageal dysmotility
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14
Q

Mechanical causes of dysphagia?

A
  • Oesophageal cancer
  • Peptic oesophagitis
  • Strictures
  • Extrinsic compression (e.g. lung cancer)
  • Systemic sclerosis
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15
Q

What can help neuromuscular dysphagia?

A

Drinking liquids and sitting upright, it is often worse with solids.

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16
Q

With mechanical dysphagia when there is weight loss and no history of reflex what should we look for?

A

Oesophageal cancer

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17
Q

Longstanding dysphagia with a history of heartburn (GORD) is suggestive of what?

A

Benign peptic stricture

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18
Q

Dyspepsia

A

Indigestion, ill-defined pain in the upper abdomen.

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19
Q

Gastro-oesophageal reflux disease.

A

Heartburn, the regurgitation of gastric acid, leaving a sour taste in ones mouth. The burning presents as an upwards radiation.

It occurs more when laying supine or bending forwards.

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20
Q

Water brash.

A

The sudden onset of excessive saliva in ones mouth

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21
Q

Dyspepsia worse with an empty stomach and eased by eating is suggestive of what?

A

Peptic ulcer disaese

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22
Q

Nausea and vomiting with abdominal pain or discomfort suggest what?

A

An upper GI disorder

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23
Q

Projectile non-bilious (not green) vomiting is suggestive of what?

A

Gastric outlet obstruction

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24
Q

If an obstruction was distal to the pylorus, what colour would vomit appear?

A

Green, due to bile.

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25
Q

Haematemesis

A

The vomiting of blood (May appear red or brown, partially digested)

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26
Q

Melaena

A

Tarry coloured, sticky, shiny, foul smelling stool. Causes by an upper GI bleed.

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27
Q

Matt black stools are associated with?

A

This is not melaena and is associated with iron or bismuth therapy.

28
Q

What due we use to predict the risk of mortality with an upper GI bleed?

A

The Rockall Score:

1) Age - older has higher risk
2) Shock - Based on HR and BP
3) Co-morbidity
4) Endoscopic findings
5) Major stigmata of recent haemorrhage

29
Q

Visceral abdomen pain.

A

Occurs due to distention of hollow organs, mesenteric contraction or excessive smooth muscle contraction.

It is a deep, poorly localised sensation in the midline.

It is conducted by the splanchnic nerves

30
Q

Somatic pain of the abdomen.

A

From the parietal peritoneum and abdominal wall.

It is lateralised and localised to the area of inflammation.

It is conducted by the intercostal (spinal) nerves.

31
Q

Pain above the umbilicus

A

Foregut = Stomach, pancreas, liver and binary system

Or Colon

32
Q

Pain around the umbilicus (Periumbilcal).

A

Pain solely from the small intestine

33
Q

Pain in the right iliac fossa

A
  • Acute appendicitis

- Crohn’s disease in the terminal ileum.

34
Q

Pain below the umbilicus

A

Colonic pain

35
Q

Pain in the left iliac fossa

A

Diverticular disease of the sigmoid colon

36
Q

Pain felt in the midline that radiates to the back.

A

Suggestive of the pancreas

37
Q

Pain radiating to the shoulder

A

Indicates peritoneal inflammation adjacent to the diaphragm ( e.g. Cholecystitis)

38
Q

A continuous pain suggests?

A

Pain from a solid organ or muscular

39
Q

Pain that last a short period before returning is suggestive of?

A

Colicky pain, it arises from a hollow structure (Small or large bowel obstruction, or the uterus in labour)

40
Q

What is wrong with the term renal and biliary colic?

A

The term colic suggests the pain last a short period, eases off and returns. This is wrong. In fact, it rapidly rises to a peak intensity and persists for several hours before resolving,

41
Q

Abdominal pain associated with an alteration in bowel habit is associated with what?

A

Irritable bowel disease, diverticular disease or colorectal cancer.

42
Q

Abdominal pain associated with features such as breathlessness or palpitation is suggestive of what?

A

Non-alimentary causes.

43
Q

Borborygmi

A

Audible bowel sounds

44
Q

Ascites

A

Accumulation of fluid in the peritoneal cavity

45
Q

Causes of ascites?

A

Common:

  • Hepatic cirrhosis with portal hypertension
  • Intra-abdominal malignancy with peritoneal spreading
  • Congestive HF

Uncommon:

  • Hepatic or portal vein occlusion
  • Constrictive pericarditis
  • Hypoproteinaemia (Nephrotic syndrome)
  • Peritonitis (Tuberculosis, pancreatitis)
46
Q

Diarrhoea

A

The frequent passage of loose stools.

47
Q

Causes of diarrhoea?

A

Acute:

  • Infective gasroenteritis
  • Drugs (e.g. antibiotics)

Chronic:

  • IBS
  • IBD
  • Parasitic infections (e.g. giardiasis lamblia)
  • Colorectal cancer
  • Autonomic neuropathy (Diabetics)
  • Laxative abuse
  • Hyperthyroidism
  • Malabsorption
48
Q

What criteria do we use to diagnose irritable bowel syndrome?

A

Rome III criteria:

Recurrant abdominal pain, for at least the last 6 month on at least 3 days per month in the last 3 months, associated with two or more of the following:

  • Improvement with defecation
  • Onset associated with change in stool frequency
  • Onset associated with change in stool form
49
Q

Constipation

A

Infrequent passage of hard stools

50
Q

Anismus

A

Evacuation of stool

51
Q

Tenesmus

A

The sensation of needing to defecate, although the rectum is empty. Suggestive of rectal inflammation or tumour.

52
Q

High volume diarrhoea

A

> 1 litre per day

  • Secretory, due to intestinal inflammation (Bacterial, viral or IBD)
  • Osmotic, due to malabsorption, adverse drug effects or motility disorder
53
Q

Steatorrhoea

A

Pale, greasy and bulky stools that float due to high lipid concentration. Associated with fat malabsorption

54
Q

Low volume diarrhoea associated with?

A

Irritable bowel syndrome

55
Q

What are the “Alarm” symptoms?

A
  • Persistant vomiting
  • Dysphagia
  • Fever
  • Weight loss
  • GI bleeding
  • Anaemia
  • Painless and water, high volume diarrhoea
  • Nocturnal symptoms disrupting sleep
56
Q

Causes of rectal bleeding

A
  • Haemorrhoids
  • Anal fissure
  • Colorectal polyps
  • Colorectal cancer
  • IBD
  • Ischaemic colitis
  • Diverticular disease (Complicated)
  • Vascular malformation
57
Q

Rectal bleeding

A

Fresh red blood

58
Q

Jaundice

A

Yellow colouring of the skin due to hyperbilirubinaemia

59
Q

What colour is the urine and stool in unconjugated hyperbilirubinaemia?

A
  • Urine = Normal
  • Stool = Normal

High urine urobolinogen

60
Q

What colour is the urine and stool in obstructive hyperbilirubinaemia?

A
  • Urine = Dark
  • Stool = Pale

High urine bilirubin

61
Q

What colour is the urine and stool in hepatocellular hyperbilirubinaemia?

A
  • Urine = Dark
  • Stool = Normal

Both urine bilirubin and urobolinogen (Both unconjugated and conjugated)

62
Q

Normal serum liver enzyme and jaundice following illness are suggestive of what?

A

Gilbert’s syndrome

63
Q

Pruritus

A

Generalised itch, may be suggestive of obstructive jaundice due to skin deposition of bile salts.

64
Q

Obstructive jaundice and abdominal pain, associated with?

A

Usually gallstones

65
Q

Obstructive jaundice, abdominal pain with fever or rigors, associated with?

A

Charcots triad - Associated with ascending cholangitis

66
Q

Painless obstructive jaundice, associated with?

A

Malignant biliary obstruction (Cholangiocarcinoma or head of the pancreas)

GI examination (2 decks)

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