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GI Flashcards

1
Q

what questions should be asked in the presenting complaint of a GI history?

A

weight alteration; how much
energy levels; fatigue?
dysphagia; food, liquids, getting worse?
dyspepsia; indigestion, acidic, waster brash, sour taste, bloating
nausea/vomiting; frequency, content, blood, bright red, coffee grounds
abdominal pain; SOCRATES
abdominal swelling; timing
bowels; diarrhoea, sluggish motions, watery, timing, nocturnal, constipation, frequency, alterations
tenesmus
blood PR; fresh, dark, black, separate, mixed, volume, mucous, pus

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2
Q

what are the causes of weight loss?

A

problems of digestion and absorption
malignancy
hyperthyroidism

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3
Q

what are the causes of dysphagia?

A

neuromuscular; liquids more than solids, choking due to aspiration
stricture; solids more than liquids
progressive; stricture due to tumour

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4
Q

what are the causes of haematemesis and melaena?

A

peptic ulcers
gastric erosions
oesophagitis
may be associated with taking aspirin or anti-inflammatory drugs

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5
Q

describe the pain coming from hollow viscera

A

colic
crampy/paroxysmal
often poorly localised
related to peristalsis

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6
Q

describe the pain from peritoneal irritation

A 
more ominous
associated with peritonitis of any sort
steady/constant
not well localised
not related to peristalsis
patient often lies still with knees up
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7
Q

what are the causes of abdominal swelling?

A 
flatus (gas); bowel obstruction
faeces
fat
fluid
foetus
organomegaly
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8
Q

what are the causes of diarrhoea?

A

e. coli
malabsorption syndrome
IBD, tumour; pathology in the rectal area which disturbs the defecation reflex

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9
Q

what conditions are important to ask about in the past medical history and family history in a GI history?

A 
bowel problems
gallstones
ulcers
arthritis
gynaecology problems

bowel cancer
IBD

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10
Q

describe the steps of an abdominal exam

A

exposure; nipples to symphysis pubis, flat bed
general inspection
superficial palpation
deep palpation
palpation for lower edge of liver
palpation for lower edge of spleen
palpation for kidneys
percussion for lower and upper edge of liver
percussion for lower edge of spleen
percussion for fluid level; shifting dullness, fluid thrill
auscultation
other examinations; external genitalia, hernia, groin, rectal

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11
Q

what is the cause of guarding?

A

inflamed viscus and peritoneum
local peritonitis
acute appendicitis

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12
Q

what is the cause of rigidity?

A

generalised peritonitis

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13
Q

what should you figure out if you feel the lower edge of the liver?

A

edge; smooth, irregular, pulsatile
distance from the liver edge and the costal margin
tenderness
consistency; hard or soft

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14
Q

what is the purpose of auscultation of the abdomen?

A

bowel sounds; 1 full minute
obstruction; tinkling bowel sounds
peritonitis; absent/reduced, widespread intra abdominal inflammation, loss of normal motility

bruits;
abdominal aorta; midline
renal arteries; right and left

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15
Q

describe the steps of an oral cavity exam

A 
general inspection
extra-oral examination;
palpation;
salivary glands
cervical lymph nodes
muscles of mastication
temporomandibular joint
consider cranial nerve/sinus examination

intra-oral examination;
dentition
mucosal surfaces
gingiva
hard and soft palate
tongue
floor of the mouth
buccal mucosa
oropharynx
assess salivary flow
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16
Q

what are you looking for in a general examination of the face in an oral cavity exam?

A

face/neck
swelling
asymmetry
bruising

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17
Q

what are you palpating for in an oral cavity exam?

A 
glands;
enlarged
tender
firm
fixed
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18
Q

how do you palpate the muscles of mastication and the temporomandibular joint?

A

temporalis; end to end and centric occlusal biting positions
masseter; palpate over the check area, ask to bite
temporomandibular joint; ask to bite, click indicates dysfunction

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19
Q

what are you looking for in an inspection of dentition?

A

identify incisor, canine, premolar and molar teeth

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20
Q

what are you looking in an inspection of mucosal surfaces?

A

inflammation; redness, swelling
ulceration
pigmentation
lesions

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21
Q

how do you inspect the tongue?

A

ask the patient to stick their tongue out; examine the dorsal surface
identify circumvallate papillae

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22
Q

how do you examine the floor of the mouth?

A

ask the patient to touch the roof of the mouth with their tongue
examine the ventral surface of the tongue

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23
Q

what are you looking for in an inspection of the buccal mucosa?

A

inflammation
ulceration
pigmentation

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24
Q

how do you examine the oropharynx?

A

is the mouth dry?

can saliva be expressed from the glands?

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25
describe an examination of a hernia
``` introduction general inspection; clinical signs objects and equipment differentiation a hernia from other types of lumps; assess both sides differentiating hernia subtypes; position reducibility direct/indirect inguinal hernia scrotal examination finish exam; thank patient, summarise findings ```
26
what should be done in the introduction of a hernia exam?
``` wash hands and don PPE introduce yourself confirm patient details explain procedure get chaperone have bed at a 45 degree angle adequately expose the patients abdomen and inguinal region ask if they have any pain ```
27
what clinical signs are you looking for in a general inspection of a hernia exam?
``` pain obvious scars abdominal distension pallor cachexia hernia; cough ```
28
what objects or equipment are you looking for in a general inspection of a hernia exam?
stoma bag; colostomies LIF, ileostomies RIF surgical drain; location, type/volume of contents mobility aids
29
what features indicate a hernia of the groin?
``` single lump in the inguinal region positive cough impulse soft on palpation reducible; unless incarcerated unable to get above the lump painless; unless incarcerated bowel sounds; may be absent if incarcerated ```
30
what features indicate that a groin lump is not a hernia?
``` multiple lumps; lymphadenopathy hard/nodular consistency; malignancy able to get above the lump; scrotal mass transillumination; hydrocoele bruits on auscultation; arteriovenous malformation ```
31
how does the position of a hernia help differentiate from different subtypes?
above and medial to the pubic tubercle; inguinal | below and lateral to the pubic tubercle; femoral
32
how does reducibility of a hernia help differentiate from different subtypes?
reducible; can be flattened by changes in position or application of pressure supine; observe spontaneous reducibility manually reduce it with your fingers reappear; standing, cough, remove pressure urgent surgical review; tender, irreducible, may be strangulated
33
how do you determine if an inguinal hernia is direct or indirect?
locate the deep inguinal ring manually reduce the hernia; press from the inferior aspect to the deep inguinal ring once reduced; apply pressure over the deep inguinal ring and cough reappears; direct inguinal hernia does not reappear; indirect inguinal hernia
34
describe inguinal hernias
protrusion of abdominal contents emerges at the superficial inguinal ring most commonly superomedial to the pubic tubercle
35
describe femoral hernias
occur just below the femoral ligament naturally occurring weakness in the abdominal wall; femoral canal higher risk of strangulation and obstruction usually inferolateral to the pubic tubercle and medial to the femoral pulse
36
describe umbilical hernias
occur at the umbilicus common can be large low risk of strangulation
37
describe incisional hernias
occur at the sites of pervious operations/surgical incisions | tissue integrity has been compromised
38
describe a scrotal examination in a hernia exam
palpation of the scrotum; if a scrotal mass is seen, with the patients consent inguinal hernia in the scrotum; will not be able to get above the mass
39
describe a stoma examination
``` introduction stoma assessment; site number of lumens spout effluent surrounding skin complications complete examination ```
40
what should be done in the introduction of a stoma exam?
wash hands introduce patient details explain expose abdomen position the patient laying flat on the bed ask if they have had any pain or recent changes in their stoma
41
describe the site of a stoma
colostomies; LIF | ileostomies; RIF
42
describe the number of lumens of a stoma
1 in RIF; end ileostomy or urostomy 1 in LIF; end colostomy 2 in RIF; loop ileostomy 2 in LIF; loop colostomy
43
describe the spouts of a stoma
present; ileostomy/urostomy absent; colostomy prevent skin irritations
44
describe the effluent of a stoma
semisolid faecal effluent; colostomy liquid faecal effluent; ileostomy urine; urostomy
45
describe the surrounding skin of a stoma
inspect for erythema, tissue breakdown, fistulation
46
what are the complications of a stoma?
parastomal hernia; reducible mass infarction; necrosis, pain prolapse; appears longer, increases when coughing or straining retraction; skins below the level of the skin haemorrhage
47
what should be done to complete a stoma examination?
thank patient wash hands summarise findings full abdominal examination
48
what should be done to complete a hernia examination?
``` thank patient wash hands summarise findings testicular examination abdominal examination inguinal lymph node assessment ```
49
describe the steps of a rectal exam
``` introduction patient position inspection of anal area; bear down palpation; clench inspection of gloved finger conclusion; clean area ```
50
how should a patient be positioned in a rectal exam?
left lateral position hips and knees well flexed buttocks at the edge of the bed
51
what are you looking for in the inspection of the anal area?
inspect the anus and the perianal area; separate the buttock skin tags; crohn's anall fissure fistula-in-ano; red spouting area, in ulcerative colitis anal warts external piles anal carcinoma; fumigating mass at the anal verge pruritus ani; red, weeping, excoriated area ask the patient to bear down; rectal prolapse
52
describe palpation in a rectal exam
lubricate index finger of right hand place finger on anal verge and tell them you are going to insert finger feel anterior, posterior and lateral aspects men anteriorly; prostate women anteriorly; cervix ask patient to clench on finger; tests degree of anal tone
53
what are you looking for when feeling the prostate?
``` size; small, medium, large consistency; soft, firm, hard surface; smooth, irregular lobes; symmetrical, asymmetrical sulcus; present, absent ```
54
what are you looking for when feeling the cervix?
masses tenderness abnormal indentations
55
what are you looking for when inspecting the finger after removed from the rectum?
``` bright blood melaena mucous pus colour of faeces ```
56
describe the introduction of a rectal examination
``` wash hands introduce yourself identify patient gather equipment explain procedure and gain consent ask for a chaperone ```
57
describe the steps of abdominal x-ray interpretation
``` confirm details assess image type and quality; projection, exposure bowels and other organs bones calcification and artefact present the x-ray ```
58
what are you looking for when assessing the image type and quality?
projection; AP supine or AP erect exposure; from diaphragm to pelvis, view both small and large bowel CXR required for small bowel perforation; free gas under the diaphragm
59
what are you looking for the in bowels and other organs section of the abdominal x-ray interpretation?
differentiate between the small and large bowel bowel diameter; small bowel 3cm, large bowel 6cm, caecum 9cm small bowel obstruction large bowel obstruction rigler's (double wall) sign inflammatory bowel disease other organs and structures
60
how do you differentiate between the small and lower bowel on an abdominal x-ray?
small bowel; central, large bowel frames it valvulae conniventes; mucosal folds of the small bowel, cross the full width haustra; large bowel pouches, not do completely transverse
61
describe the features of small bowel obstruction on an abdominal x-ray
dilatation >3cm prominent valvulae conniventes; coiled spring appearance causes; adhesion, abdominal hernias, intrinsic or extrinsic compression by neoplastic masses
62
describe the features of large bowel obstruction on an abdominal x-ray
sigmoid volvulus; coffee bean appearance caecal volvulus; fetal appearance causes; colorectal carcinoma, diverticular strictures, hernias, volvulus
63
describe rigler's sign on an abdominal x-ray
both sides of the bowel wall become visible; pneumoperitoneum free air under diaphragm on erect CXR causes; perforated bowel, perforated duodenal ulcer, recent abdominal surgery
64
what are the features of inflammatory bowel disease on an abdominal x-ray?
thumb printing; mucosal thickening of the haustra due to inflammation and oedema lead pipe colon; loss of normal haustra markings, chronic colitis toxic megacolon; chronic dilatation without obstruction, colitis
65
describe the important features of other organs and structures on an abdominal x-ray
lungs; basal pneumonia can cause abdominal pain liver gallbladder; calcified gallstones, cholecystectomy clips stomach psoas muscle kidney spleen; LUQ, superior to left kidney bladder; variable appearance depending on fullness
66
what are the bony structures usually visible on an abdominal x-ray?
``` ribs lumbar vertebrae sacrum coccyx pelvis proximal femurs ``` fractures, osteoarthritis, Paget's disease, bony metastases
67
what are the causes of calcification or artefact on an abdominal x-ray?
``` calcified gallstones; RUQ renal stones, staghorn caliculi pancreatic calcification vascular calcification costochondral calcification contrast; following barium surgical clips jewellery; belly button rings ```
68
what questions should be asked in the presenting complaint of a urinary history?
``` hesitancy poor stream incomplete emptying terminal dribbling urgency frequency nocturia incontinence; stress, urge dysuria loin/back pain fever/rigors haematuria cloudy/malodorous urine polyuria anuria/oliguria sexual history ```
69
describe the symptoms and causes of urinary voiding problems
hesitancy poor stream; stops and starts, stops completely, irritative, voiding dysfunction incomplete bladder emptying terminal dribbling bladder outflow obstruction; BPH, stricture, meatal stenosis
70
describe the symptoms and causes of urinary storage problems
``` urgency frequency nocturia incontinence; stress incontinence, incontinence pads, volume, at night, after voiding urge incontinence ``` overactive bladder, BPH
71
what are the symptoms of renal disease
``` tiredness dyspnoea on exertion; anaemia, pulmonary oedema chest pain; anaemia, pericarditis nausea and vomiting ankle oedema abdominal swelling; ascites pruritius bone pain thirst ```
72
what questions should be asked during the past medical history of a urinary history?
``` neurology; MS, cerebrovascular disease HTN diabetes previous surgery; for urinary incontinence in women and prostatic hypertrophy in men, ureteric injury obstetric history ```

OSCEs (11 decks)

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