gastro exam

Question 1

what should be position?

Answer 1

lying flat

Question 2

general inspection list 6

Answer 2

jaundice
anaemia 
tattooes 
distension 
medical parephrenelia

Question 3

why would you ask the patient to cough in an abdo exam?

Answer 3

coughing increases intraabdominal pressure which would cause an inguinal hernia to appear

Question 4

what gastro causes results in anaemia?

Answer 4

GI bleed
malignancy
malnutrition / absorption

Question 5

3 causes of jaundice?

Answer 5

acute hepatitis
liver cirrhosis
cholangitis

Question 6

why would there be hyperpigmentation present in a patient with a gastro condition?
what does it make you think of?

Answer 6

haemochromatosis

Question 7

oedema
how does it present
what does it relate to in an abdo exam/

Answer 7

ascites

liver failure

Question 8

medical paraphrenelia?

Answer 8

stoma bags
surgical drains
feeding tubes

Question 9

signs on the palms?

Answer 9

palmar erythema

dupuytrens contracture

Question 10

what is koilonychia and when does it present ?

Answer 10

spoon-shaped nails, associated with iron deficiency anaemia (e.g. malabsorption in Crohn’s disease).

Question 11

what is leukonychia

why does _____ cause it?

Answer 11

whitened nail bed
assoiciated with hypoalbuminaemia
end stage liver disease
protein losing enteropathy

hypoalbuminaemia would cause edematous state in the nail bed which could mean pressure applied by excessive fluid hides the normal red state

Question 12

abdo causes of clubbing?

Answer 12

IBD
coeliac disease
liver cirrhosis

lymphoma

Question 13

why do you assess astrexis in an abdo exam?

Answer 13

co2 retention when type 2 resp failure

but abdo causes - known as the hepatic flap
suggests hepatic encephalopathy - dysregulation of the diencephalic motor centers in the brain that regulate innervation of muscles responsible for maintaining position hence the flap - due to hyperammoniaemia

uraemia 2ndary to renal failure

Question 14

dupuytrens contracture

what is it ?

why does it occur
how to assess

what does it feel like?

Answer 14

thickening of the palmar fascia
contracture deformities pulling thumb / fingers

most commonly fourth or fifth fingers

feels like thickened palmar fascia

diabetes
alcohol abuse
hiv infection

Question 15

why do you need to inspect axilla for abdo?

what shows insulin resistance or GI malignancy?

Answer 15

acanthosis nigricans
darkening / thickening of armpits

hair loss of axilla is associated with iron deficiency anaemia and malnutrition

Question 16

what signs can be present on the arms?
bruising
excoriations
needle track marks

Answer 16

bruising-
suggests clotting factors may be deranged - hepatic problem

excoriations
scratch marks - pruritus suggests cholestasis and high bilirubin in blood causes itching

track marks
iv drug use - hepatitis b/c

Question 17

IBD ? CROHNS

what signs on examination suggest IBD

Answer 17

eye: inflammation of area next to iris - anterior uveitis - crohns

Question 18

mouth signs anaemia / iron deficiency

Answer 18

angular stomatitis
glossitis
Aphthous ulceration

Question 19

b12 / folate deficiency mouth signs

what is glossitis ?

Answer 19

glossitis is smooth enlargement of really red tongue

Question 20

what are all the mouth signs you should look out for?

Answer 20

angular stomatis
glossitis
oral candidiasis - immunosuppression/ fungal infection

aphthous ulceration
hyperpigmented macules - pathogonomic for peutz- jeghers syndrome polyps in GI tract

Question 21

virchows node
what is it?
what is it significance?

Answer 21

left supraclavicular lymph node recieves it’s lymphatic drainage from the abdominal cavity

so its enlargement in an abdo context is alarming for malignancy - metastatic

Question 22

spider naevia - what is this?

why does it occur
what hormone is increased in circulation?

how many is significant?

Answer 22

skin lesions that have a central red papule with fine red lines

caused by increased oestrogen

> 5 abnormal

suggestive of liver cirrhosis

Question 23

signs on chest?

Answer 23

spider naevi
gynaecomastia
hair loss

all occur due to inc oestrogen circulating
and they all suggest liver cirrhosis

Question 24

why is increased circ oestrogen suggestive of cirrhosis

Answer 24

liver is responsible for metabolizsing and inactivating estrogen so increased oestrogen signs suggest liver dysfunction reliably

Question 25

6 f's of abdo distension?

Answer 25

``` fulminant mass fetus faeces flatus fat fluid ```

Question 26

what is bruising around the umbilicus called?

Answer 26

cullens

Question 27

bruising in flanks?

Answer 27

grey turners | haemorrhagic pancreatitis

Question 28

caput medusae

Answer 28

engorged paraumbilical veins | associated with portal hypertension

Question 29

if a mass is found what should you assess about it? | 5

Answer 29

``` location size/ shape consistency mobility pulsatility ```

Question 30

why do you ask to breath in when palpating?

Answer 30

diaphragm moves up liver moves down

Question 31

how do you assess the liver edge? how much extension is significant? what kind of consistency suggests cirrhosis what is pulsatile hepatomegaly associated with?

Answer 31

Degree of extension below the costal margin: if greater than 2 cm this suggests hepatomegaly. consistency of the liver edge - nodular cirrhosis tricuspid regurgitation

Question 32

murphys sign positive?

Answer 32

cholecystitis | deep inspiration palpate mcl right costal margin

Question 33

for splenomeglay to be noted how much bigger would the spleen need to be? causes of splenomegaly?

Answer 33

``` 3x hemolytic anaemia - sickle cell portal hypertension 2 liver cirrhosis glandular fever heart failure ```

Question 34

do you ballot the kidneys on inspiration or expiration and why? what are causes of an enlarged kidney?

Answer 34

on inspiration polycystic kidney disease amyloidosis

Question 35

ascities

Answer 35

percuss from middle to patients left ask patient to turn towards you wait 30 seconds repeat resonant > dull then once turned towards you the dull area would not be resonant

Question 36

what does pitting oedema of the legs suggest?

Answer 36

hypoalbuminaemia - liver cirrhosis / protein losing enteropathy

Question 37

bruits - abdo

Answer 37

aortic- 1-2cm superior to umbilicus renal bruits - 1-2 cm superior and slightly lateral to midline on either side renal artery stenosis

Question 38

PT presents with impulsiveness and psychiatric symptoms but is referred for a gastro review examination: ataxia on entering room, rigidity of muscles in neuro limb exam hands had a tremor, scleral icterus, kayser fleischer rings in the eyes were observed Coombs negative haemolytic anaemia mild hepatomegaly what condition ? what is its etiology of disease? Ix? Mx?

Answer 38

wilsons disease- autosomal recessive excess copper stored in tissues which when liberated can cause the kayser fleischer rings and non immune haemolytic anaemia 24 hr urinary collection is ix of choice atp7b gene diagnosis confirms Mx chelators : D-penicillamine +zinc salts

Question 39

female pt presents with lethargy, erectile dysfunction and polyuria, polydipsia and nocturia - she thinks it may be as a result of her menopause and periods ending on examination pt seems very tanned despite no holiday jaundice, ascites and stigmata of disease on the cuticles on palpation ; hepatomegaly , cardiac failure signs what is wrong with the pt? Ix? Mx?

Answer 39

Haemochromatosis Ferritin, transferrin saturation , TIBC- the binding capacity is low as there is so much iron going Venesection

Question 40

how does Deferoxamine work what does it treat is it first line or second line?

Answer 40

binds to iron and allows it to be excreted haemochromatosis second line

Question 41

If mx includes IV fluids what do you say?

Answer 41

I would ensure it is documentated how much fluid input /output is happening ensure reassessment clinically and biochemicallly