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Phase 2b Medicine > Gastro Exam > Flashcards

Gastro Exam Flashcards

1
Q

What is the importance of confusion in an abdominal exam?

A
  • Feature of end-stage liver disease (hepatic encephalopathy)
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2
Q

What may abdominal distension indicate?

A
  • Presence of ascites or underlying bowel obstruction and/or organomegaly
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3
Q

What is the relevance of pallor in a abdominal exam?

A

Underlying anaemia e.g. GI bleed or malnutrition

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4
Q

What may jaundice indicate?

A
  • High bilirubin levels

- Acute hepatitis, liver cirrhosis, cholangitis, pancreatic cancer

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5
Q

Why might there be hyperpigmentation in an abdominal exam?

A

Associated with haemochromatosis

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6
Q

What is the relevance of oedema in an abdominal exam?

A

Associated with liver cirrhosis - impaired albumin production

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7
Q

What is cachexia?

A

Ongoing muscle loss that isn’t entirely reversed with nutritional supplementation

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8
Q

What is cachexia associated with?

A
  • Underlying malignancy

- Advanced liver failure

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9
Q

What signs are there on the palms of the hands in a abdomen exam?

A
  • Pallor
  • Palmar erythema
  • Dupuytren’s contracture
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10
Q

What is palmar erythema and what may it be seen in?

A
  • A redness involving the heel of the palm

- Chronic liver disease

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11
Q

What is koilonychia?

A

Spoon-shaped nails, associated with iron deficiency anaemia

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12
Q

What is leukonychia?

A

Whitening of the nail bed, associated with hypoalbuminaemia

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13
Q

What is leukonychia seen in?

A
  • End stage liver disease

- Protein-losing enteropathy

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14
Q

Why might clubbing be seen in a abdominal exam?

A
  • IBD
  • Coeliac disease
  • Liver cirrhosis
  • GI lymphoma
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15
Q

What is the causes of asterixis in an abdominal exam?

A
  • Hepatic encephalopathy (due to hyperammonaemia)

- Uraemia secondary to renal failure

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16
Q

What should be completed on palpation of the hands in an abdominal exam?

A
  • Temperature
  • Radial pulse
  • Dupuytren’s contracture
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17
Q

What is Dupuytren’s contracture?

A

Thickening of the palmar fascia

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18
Q

When may Dupuytren’s contracture be seen?

A
  • Genetic
  • Excessive alcohol use
  • Increasing age
  • Male
  • Diabetes
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19
Q

What should be noted on inspection of the arms in an abdominal exam?

A
  • Bruising (secondary to liver disease)
  • Scratch marks (due to pruritus - cholestasis)
  • Needle track marks (viral hepatitis)
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20
Q

What is Grey Turner’s sign?

A
  • Brusing of the flank

- Predicts acute haemorrhage pancreatitis

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21
Q

What is Cullen’s sign?

A

Bruising of tissue surrounding the umbilicus associated with haemorrhagic pancreatitis

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22
Q

Why may acanthosis nigricans occur in an abdominal exam?

A
  • Associated in insulin resistance

- GI malignancy e.g. stomach cancer

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23
Q

What is the relevance of axillary hair loss in an abdominal exam?

A
  • Iron-deficiency anaemia

- Malnutrition

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24
Q

What is important to inspect in the eyes in an abdominal exam?

A
  • Conjunctival pallor
  • Jaundice
  • Corneal arcus
  • Xanthelasma
  • Kayser-Fleischer rings
  • Perilimbal injection
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25
Q

What is corneal arcus?

A

Hazy white/grey ring around cornea, indicates hypercholesterolaemia

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26
Q

What is xanthelasma?

A

Yellow cholesterol deposits around the eye - hypercholesterolaemia

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27
Q

What are Kayser-Fleischer rings associated with?

A

Wilson’s disease - may also cause liver cirrhosis

28
Q

What is perilimbal injection?

A
  • Inflammation of the area of conjunctiva
  • Sign of anterior uveitis
  • Associated with IBD
29
Q

What should be inspected for in the mouth in an abdominal exam?

A
  • Angular stomatitis
  • Glossitis
  • Oral candidiasis
  • Aphthous ulceration
  • Hyperpigmentated macules
30
Q

What is angular stomatitis?

A
  • Inflammatory condition affecting corners of the mouth

- Iron deficiency as cause

31
Q

What is glossitis?

A
  • Smooth erythematous enlargement of the tongue
  • Associated with iron, B12 and folate deficiency
  • Secondary to IBD
32
Q

What may cause aphthous ulceration?

A
  • Iron, B12, folate deficiency

- Crohn’s disease

33
Q

What may hyperpigmentated macules indicate?

A
  • Peutz-Jeghers syndrome, which leads to polyp development
34
Q

What may enlargement of Virchow’s node indicate?

A
  • Metastatic intra-abdominal malignancy

- On the left side of the patient

35
Q

What are spider naevi and what do they indicate?

A
  • Skin lesions that have a central red papule with fine red lines
  • Usually associated with liver cirrhosis
36
Q

What is the relevance of gynaecomastia in a abdominal exam?

A
  • May be caused by increased oestrogen, indicating liver cirrhosis
37
Q

What are the 6 f’s of abdominal distension?

A
  • Fat
  • Fluid
  • Flatus
  • Faeces
  • Fetus
  • Fulimant mass
38
Q

What is caput medusae and what is it associated with?

A
  • Large periumbilical veins associated with portal hypertension
  • Associated with liver cirrhosis
39
Q

What is rebound tenderness?

A
  • Slow compression of the abdomen and quick release
  • Results in sudden sharp abdominal pain
  • Associated with peritonitis e.g. appendicitis
40
Q

What is guarding?

A
  • Involuntary tension in abdo muscles on palpation

- Associated with peritonitis e.g. appendicitis, diverticulitis

41
Q

What is Rovsing’s sign?

A
  • Palpation of the left iliac fossa causes pain in the right iliac fossa
  • Suggestive of peritonitis
42
Q

What may pulsatility of palpation mean in an abdominal exam?

A

Suggestive of vascular aetiology e.g. AAA

43
Q

What does it mean if the degree of extension below the costal margin of the liver is greater than 2cm?

A

Hepatomegaly

44
Q

What does a nodular consistency of the liver indicate in a liver exam?

A

Cirrhosis

45
Q

What does hepatic tenderness indicate?

A
  • Hepatitis

- Cholecystitis

46
Q

What is pulsatile hepatomegaly associated with?

A

Tricuspid regurgitation

47
Q

Name 6 causes of hepatomegaly

A
  • Hepatitis
  • Hepatocellular carcinoma
  • Wilson’s/haemochromatosis
  • Leukaemia/myeloma
  • Tricuspid regurgitation
  • Haemolytic anaemia
48
Q

What may make the gallbladder palpable?

A
  • Enlargement secondary to biliary flow obstruction

- Pancreatic malignancy, gallstones, cholecystitis

49
Q

What is Murphy’s sign and what makes it positive?

A
  • Ask patient to take deep breath while palpating

- If they stop mid-breath due to pain, it indicates cholecystitis

50
Q

What does a distended painless gallbladder indicate?

A

Pancreatic cancer

51
Q

Should the spleen be be able to be palpated?

A

NO!

52
Q

Name 5 causes of splenomegaly

A
  • Portal hypertension secondary to liver cirrhosis
  • Haemolytic anaemia
  • Congestive heart failure
  • Splenic metastases
  • Glandular fever
53
Q

Name a cause for a bilaterally enlarged kidney

A

PKD or amyloidosis

54
Q

Name a cause for a unilaterally enlarged kidney

A

Renal tumour

55
Q

What is the healthy movement of the hands when palpating the abdominal aorta?

A

Should move superiorly

56
Q

What does it mean when your hands move outwards when palpating the abdominal aorta?

A

An expansile mass e.g. abdominal aortic aneurysm

57
Q

What may cause a distended bladder which could be palpated?

A

Urinary obstruction/retention

58
Q

Should you be able to percuss the spleen normally?

A

No, it only should be when there is splenomegaly

59
Q

What does shifting dullness show?

A

The presence of ascites. This is when the percussion goes from dull to resonant in the flank.

60
Q

What is a normal bowel sound?

A

Gurgling

61
Q

What does a tinkling bowel should show?

A

Bowel obstruction

62
Q

What may cause absent bowel sounds?

A

An ileus (when there is a lack of movement in the bowels)

63
Q

What bruits should be listened to in an abdominal exam?

A
  • Aortic bruit

- Renal bruit

64
Q

What may an aortic bruit be associated with?

A

Abdominal aortic aneurysm

65
Q

What may a renal bruit be associated with?

A

Renal artery stenosis

66
Q

What may pitting oedema indicate in an abdominal exam?

A
  • Hypoalbuminaemia, so liver cirrhosis or protein-losing enteropathy
67
Q

What should be completed at the end of an abdominal exam?

A
  • Hernial orificies check
  • DRE
  • External genitalia examination

Phase 2b Medicine (17 decks)

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