List the 9 common symptoms of GI diseases
Disturbed bowel habit (constipation, diarrhoea)
Name three filling (irritative) symptoms of the lowe urinary tract
frequency, urgency, nocturia, dysuria
Name four voiding (obstructive) symptoms of the lower urinary tract
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,
Name 7 signs of chronic liver disease
Loss of axillary hair
What is guarding?
reflex contraction of the abdominal muscles on light palpation. Associated with localised pain due to inflammation of the parietal peritoneum
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.
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
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
List 3 possible causes of hepatomegaly
congestive heart failure
List 3 possible causes of splengomegaly
Name two diseases which cause both hepatomegaly and splengomegaly
Name the 5 causes of abdominal distension
Flipping big mass (tumour)
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.
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
List three causes of obstructive jaundice
Obstruction of the common bile duct
Cancer (bile duct or head of the pancreas)
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)
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
Grey turner's sign
Bruising of the flanks associated with retroperitoneal haemorrhage. Sign of acute pancreatitis
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.
Causes of hypoactive bowel sounds
Causes of hyperactive bowel sounds
Inflammatory bowel disease
Mechanical bowel obstruction
Abdominal causes of clubbing
Blood investigations in patients with IBD
FBC - anaemia
CRP, ESR - inflammation
Albumin - malnutrition
Drugs used in treatment of IBD
Aminosalicylates: long term prevention of remission
DMDs: maintains remission long term
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)
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