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Examinations > Gastrointestinal System > Flashcards

Gastrointestinal System Flashcards

1
Q

Ddx Dupytrens contacture

A

CLD, diabetes, heavy labour, phenytoin, trauma, familial

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2
Q

Ddx Palmer erythema

A

CLD, pregnancy, hyperthyroidism, RA

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3
Q

Ddx finger clubbing

A

IBD, Cirrhosis, lymphoma, coeliac disease

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4
Q

Ddx leuconychia

A

Hypoalbuminaemia - CLD and other causes

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5
Q

Ddx koilonychia

A

Iron-deficiency anaemia e.g GI bleed

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6
Q

Ddx flapping tremor

A

Hepatic failure, respiratory/ renal failure

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7
Q

Bruising

A

CLD - thrombocytopenia, clotting factors, falls

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8
Q

Ddx cushingoid features

A

Alcohol abuse, long term steroids, Cushings disease

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9
Q

Signs and indications in the eyes

A

Scleral icterus - jaundice (implies serum bilirubin > 35 micromol/l)

Corneal arcus & xanthelasma - hyperlipidaemia (PBC & cholestasis)

Episcleritis / conjunctivitis - IBD

Conjunctival pallor - anaemia

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10
Q

Signs and indications in the mouth

A

Angular stomatitis & glossitis - iron/ folate/ B12 deficiency

Oral candidiasis - immunodeficiency or steroids

Apthos ulcers - IBD (esp Crohns)

Fentor helaticus - hepatic failure (mercaptan accumulation)

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11
Q

Ddx gynaeconastia

A

CLD, drugs, testicular failure

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12
Q

How do you confirm spider naevi, what distribution do they follow?

A

Depress to demonstrate filling - occur in distribution of SV. More than 5 suggest CLD

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13
Q

Causes of abdominal distension

A

6Fs -Fat, fluid, flatus, faeces, fetus, flipping big masses (Ca)

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14
Q

What does shifting dullness indicate?

A

Ascites - > 1.5l fluid present (fluid and dullness shifts with gravity)

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15
Q

Ddx peripheral oedema

A

CLD and other causes - RHF, lung fibrosis

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16
Q

Other than oedema, what other GI sign might you see in the legs and what are these indicative of?

A

Erythema nodusum (IBD) and pyoderma gangrenosum (IBD, RA)

17
Q

Concluding remarks

A

Examine groins (hernia), genitalia (testicular atrophy in CLD), perform PR exam

Obs chart (BP, temp, SaO2)

18
Q

Ddx ascites - transudate

A 
CLD
RHF
Volume overload
Hypoalbuminaemia
Constrictive pericarditis
19
Q

Ddx ascites - exudate

A

Infection - spontaneous bacterial peritonitis, TB

Inflammation - pancreatitis

Malignancy - luminal (stomach/ colon), pancreas, liver, ovarian, lymphoma

20
Q

Ddx hepatomegaly

A

2 Is, 2 Bs, 2 Cs

Infection - viral hepatitis, EBV, Malaria, hepatic abscess

Infiltration - sarcoid, amyloid, fatty liver, haemochromatosis

Blood related - lymphoma, leukaemia, myeloproliferative disorders, haemolytic anaemia

Biliary - PBC, PSC

Cancer - primary HCC, Metastatic deposits

Congestion - RHF, tricuspid regurgitation, Budd- Chiari syndrome

21
Q

Ddx hepatosplenomegaly

A

Infection - viral hepatitis, EBV, Malaria, hepatic

Infiltration - sarcoid, amyloid, fatty liver, haemochromatosis

Blood related - lymphoma, leukaemia, myeloproliferative disorders, haemolytic anaemia

22
Q

Extra-intestinal signs of IBD

A 
Finger clubbing
Mouth ulcers (esp Crohns)
Eyes - episcleritis & conjunctivitis
Skin - erythema nodosum, pyoderma gangrenosum
Joints - serinegative spondylarthropathy
PSC (esp UC)
Amyloidosis (esp Crohns)
23
Q

Ddx gynaecomastia

A 
Physiological (puberty/ elderly)
Testicular failure (kleinfelters, trauma, viral orchitis, haemodialysis)
Increase oestrogen (CLD, thyrotoxicosis, oestrogen inducing tumour)
Drug induced (digoxin, isoniazid, Spiro)
24
Q

Causes of massive splenomegaly

A

Malaria
Myelofibrosis
chronic Myeloid leukaemia

25
Q

Other causes of splenomegaly

A

Infective endocarditis, RA

26
Q

Signs of portal hypertension

A

Capitol medusae, oesvageal varices, gastropathy, & ascites

27
Q

Ddx smooth liver edge

A

Venous congestion

Fatty infiltration

28
Q

Ddx knobbly liver edge

A

Metastases

Cysts

29
Q

Ddx pulsatile liver edge

A

Tricuspid regurgitation

30
Q

Ddx tender liver edge

A

Hepatitis

RHF (capsular pain)

31
Q

Ddx of liver edge Bruit

A

HCC
AV malformation
TIPPS (transjugular intrahepatic Porto-systemic shunt

32
Q

How could you differentiate between spleen and left kidney?

A 
You get your hand over a kidney
Percussion note is resonant over kidney
Kidney is balottable
Spleen has a notch
Spleen moves more on respiration
33
Q

Ddx tendon Xanthomata

A

hyperlipidaemia (PBC, cholestasis)

34
Q

Ddx lower right quadrant pain

A 
Appendicitis
Intestinal obstruction
Regional enteritis
Diverticulitis
Cholecystitis
Ectopic pregnancy
Ovarian cyst or torsion
Endometriosis
Salpingitis
Uterical calculi
Seminal vesiculitis
Psoas abscess
35
Q

Ddx lower left quadrant pain

A 
Diverticulitis
Intestinal obstruction
Appendicitis
Ectopic pregnancy
Ovarian cyst or torsion
Endometriosis
Salpingitis
Uterical calculi
Seminal vesiculitis
Psoas abscess
36
Q

Ddx left upper quadrant pain

A 
Gastritis
Pancreatitis
Splenic enlargement, rupture, infarction
Renal pain
Herpes zoster
MI
Pneumonia
Empyema

Examinations (15 decks)

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