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Flashcards in GI & abdominal examination Deck (27):
1

List the 9 common symptoms of GI diseases


Nausea
Dysphagia
Vomiting
Heartburn/Indigestion
Abdominal pain
Abdominal swelling
Weight loss
Jaundice
Disturbed bowel habit (constipation, diarrhoea)



 

 

2

Name three filling (irritative) symptoms of the lowe urinary tract

 frequency, urgency, nocturia, dysuria

 

3

Name four voiding (obstructive) symptoms of the lower urinary tract

poor stream

hesitancy

terminal dribbling

incomplete voiding

overflow incontinence

4

Name six systemic features of inflammatory bowel disease

General: Fever, malaise, weight loss

Eyes: Conjunctivitis, episcleritis, 

Joints: arthralgia of large joints, anylosing spondilitis

Skin: Mouth ulcers, erythema nodosum

Liver: Fatty liver, gall stones,

 

5

Name 7 signs of chronic liver disease

Finger clubbing

Leukonychia

Palmer erythema

Dupuytren's contracture

Spider naevi

Gynaecomastia

Peripheral oedema

Parotid enlargement

Loss of axillary hair

6

What is guarding? 

reflex contraction of the abdominal muscles on light palpation. Associated with localised pain due to inflammation of the parietal peritoneum

7

What is rebound?

Pain caused by the sudden withdrawl of a firmly applied hand on the abdominal wall. Suggests the presence of an underlying inflamed organ.

8

Why would you see visible peristalsis in a patient?

In cases of pyloric stenosis, dilated obstructed stomach forms a prominent swelling in the upper abdomen

9

What is asterixis?

Flapping tremous seen in hepatic encephalopathy. When arms are stretched out, patient's cannot keep wrists extended for 15-30 seconds, flapping of the hands visible

10

List 3 possible causes of hepatomegaly

Viral hepatitis

cirrhosis

congestive heart failure

alcholic hepatitis

hepatocellular cancer

hepatic metastasis

11

List 3 possible causes of splengomegaly

portal hypertension

haemolytic anaemia

infection

12

Name two diseases which cause both hepatomegaly and splengomegaly

lymphoma

cirrhosis

sarcoidosis

amyloidosis

myelofibrosis

13

Name the 5 causes of abdominal distension

Flatus

Faeces

Fluid

Foetus

Flipping big mass (tumour)

14

Explain the mechanism of Murphy's sign

Murphy's sign is elicited on palpating at the costal margin of the right upper quadrant.

The patient is instructed to exhale and a hand is placed on the costal margin.

On inspiration as the diaphragm pushes down the liver and gall bladder move with it. If the gall bladder is inflamed then the patient will experience a sharp pain as the gall bladder contacts the palpating hand and stop mid-inhalation.

15

List 15 clinical signs present in patients with Chronic liver disease

Classic signs: oedema Muscle wasting Leukonychia Clubbing Jaundice Portal hypertension: Caput's medusa As cites Splenomegaly Oestrogen excess: Gynacomastia Testicular atrophy Loss of body hair Palmar erythema Spider naevi Others: Duputyren's contracture Parotid enlargement

16

List three causes of obstructive jaundice

Obstruction of the common bile duct

Cancer (bile duct or head of the pancreas)

Biliary stricture

 

17

List 3 possible causes for dysphagia

1. Intrinsic lesion (tumour, stricture)

2. Extrinsic pressure (enlarged thyroid, aortic aneurysm, bronchial cancer)

3. Motility disorder (aperistalsis or neurological disorder)

18

Blood in the stools (3 types of presentation)

Black, tar-like: Meleana. Indicative of an upper GI bleed. Blood is then modified by the activity of intestinal bacteria as it passes through the bowel. Continuous, profuse bleeding. Dark red: blood is unchanged, therefore lower GI bleed. Profuse bleeding indicative of rupture e.g. Diverticular disease Intermittent bright bed blood: bleeding in the rectum or anal canal, likely due to polyps or haemorrhoids

19

Grey turner's sign

Bruising of the flanks associated with retroperitoneal haemorrhage. Sign of acute pancreatitis

20

How would you examine a patient for ascites?

Percuss for 'shifting dullness'

Percuss from the umbilicus down the right side of the abdomen, if an area of dullness is detected keep two fingers on it and ask the patient to roll to the left.

Percuss again from the lower side after 30 seconds. If ascites is present, dullness will have shifted upwarsd due to the redistribution of fluid.

21

Causes of hypoactive bowel sounds

Constipation

General anathesia

Abdominal surgery

Paralytic ileus

Anticholinergics/opiates

22

Causes of hyperactive bowel sounds

Diarrhoea

Inflammatory bowel disease

GI bleeding

Mechanical bowel obstruction

23

Abdominal causes of clubbing

Hepatic cirrhosis

Chrons disease

Coeliacs disease

Ulcerative colitis

24

Blood investigations in patients with IBD

FBC - anaemia

CRP, ESR - inflammation

Albumin - malnutrition

25

Drugs used in treatment of IBD

Steroids: Imunnosuppressant

Aminosalicylates: long term prevention of remission

DMDs: maintains remission long term

mAbs

26

Use of steroids in IBD

Glucocorticoids inhibit synthesis of pro-inflammatory cytokines.

Used for short periods to induce remission. Long term treatment causes side effects (e.g. osteoporosis, muscle wasting, diabetogenic, water retention)

27

Immunomodulators used in IBD

Azathioprine: Antimetabolite for purines in nucleic acid synthesis. Modify lymphocyte function.

Methotraxate: Folic acid antagonist

Cyclosporin: IL2R inhibitor. Inhibits B-cell activation

Cause bone marrow suppression, nausea, vomiting