GI week: Hx & Ex

Question 1

Cardinal symptoms in GI history

Answer 1

• painful mouth
• difficulty swallowing
• heartburn
• abdominal pain
• nausea, haematemesis
• bowels
• rectal bleeding
• flatulence
• jaundice
• fever
• weight loss

Question 2

GI causes of clubbing

Answer 2

• Liver cirrhosis
• IBD
• malabsorption

Question 3

What causes palmar erythema and spider naevi in GI conditions

Answer 3

Excess oestrogen due to reduced hepatic breakdown of sex steroids

Question 4

Causes of leukonychia

Answer 4

conditions leading to lack of protein

• hypoalbunimaemia
• Kwashiokor (protein malnutrition)
• Coeliac’s (protein losing enteropathy)
• Nephrotic syndrome (prolonged proteinuria)

Question 5

Causes of Dupytrene’s contracture

Answer 5

• Alcohol related chronic liver disease
• Congenital
• Diabetes
• Smoking
• High cholesterol
• HIV

Question 6

What might bilateral parotid swelling indicate

Answer 6

• Chronic alcohol abuse

- Bulimia

Question 7

Difference between telangiectasia and spider naevi

• direction of flow
• blanching characteristics

Answer 7

Telangiectasia flow from outside in

Spider naevi flow from inside out

Telangiectasia do not blanch with pressure

Spider naevi blanch with pressure

Question 8

What GI condition might mouth ulcers indicate

Answer 8

Crohn’s

Question 9

What are iritis and episcleritis associated with

Answer 9

IBD (Crohn’s, UC)

Question 10

What might glossitis and angular stomatitis indicate

Answer 10

Iron deficiency anaemia/ B12/ folate deficiency

Question 11

How to feel difference between expansile and pulsatile aorta on palpation

Answer 11

Expansile: fingers pushed apart from each other

Pulsatile: fingers pushed away from abdomen

Question 12

What 4 features on examination indicate liver failure

Answer 12

1. Fetor hepaticus (stale mousy smell)
2. Flapping tremor
3. Varied mental state (from drowsy to coma)
4. Late neurological features - spasticity and extension of arms and legs. Extensor plantar responses

Question 13

Peptic ulcer and duodenal ulcer

• in which do you lose/ gain weight

Answer 13

Lose weight with peptic ulcer

Gain weight with duodenal ulcer

Question 14

What do the following GI pains suggest:

• worse during eating
• better with eating
• just after eating
• a little more time after eating

Answer 14

Worse during eating: stomach problem

Better during eating: duodenum

Just after eating: reflux

A little more time after eating: problem further down in bowels

Question 15

What might cause dysphagia with solids

Answer 15

Strictures from reflux or cancer

stuck in oesophagus

Question 16

What might cause dysphagia with fluids

Answer 16

Neurological problem with musces

stuck in pharyngeus

Question 17

What condition might the following symptoms indicate

• pain radiating to genitalia
• patient was dehydrated

Answer 17

Renal colic

Question 18

Causes of hepatomegaly

Answer 18

• chronic liver disease
• cancer
• RHF
• blood disorders (lymphoma, leukaemia, myelofibrosis, polycythaemia)

Question 19

Causes of splenomegaly

Answer 19

• blood disorders (myeloid leukaemia, myelofibrosis)
• portal hypertension
• infection (malaria)
• rheumatoid conditions: RA, SLE

Question 20

Causes of hepatosplenomegaly

Answer 20

• lymphoma
• myeloproliferative disease
• cirrhosis
• portal hypertension

Question 21

Which abdominal organs are retroperitoneal

Answer 21

SAD PUCKER

Suprarenal (adrenal) glands
Aorta, IVC
Duodenum
Pancreas
Ureteres
Colon
Kidneys
Esophagus
Rectum

Question 22

Embryologically, which parts of the GI tract are the

• foregut
• midgut
• hindgut

Answer 22

Foregut: oesophagus -> 2nd part duodenum

Midgut: 2nd part duodenum -> proximal 2/3 transverse colon

Hindgut: Distal 1/3 transverse colon -> rectum

Question 23

Describe the Grey Turners sign.

What is it a feature of?

Answer 23

Bruising of flanks (sign of retroperitoneal haemorrhage)

Indicates acute pancreatitis (leading to necrosis)

Question 24

Describe the Cullens sign.

What is it a feature of?

Answer 24

Superficial oedema and bruising around umbilicus (in subcutaneous fatty tissue)

May indicate:

• acute pancreatitis
• ruptured AAA
• ruptured ectopic pregnancy

Question 25

Causes of koilonychia

Answer 25

Iron deficiency anaemia

Question 26

3 signs of peritonitis

Answer 26

1. rebound tenderness 2. percussion tenderness 3. guarding

Question 27

Which side do ileostomy and colostomy tend to appear on

Answer 27

Ileostomy: R side Colostomy: L side

Question 28

Where might pain from biliary colic radiate to?

Answer 28

Below R scapula

Question 29

Describe Murphy's sign

Answer 29

for cholecystitis Push in RUQ, pain on inspiration disrupting breath

Question 30

Describe Rovsing's sign

Answer 30

for appendicitis Push LIF but they feel pain in RIF

Question 31

Describe McBurney's point

Answer 31

for appendicitis RIF pain

Question 32

Over what age is renal colic rare

Answer 32

>65

Question 33

In patients >65 presenting with symptoms similar to renal colic, what must be excluded

Answer 33

AAA

Question 34

What is the criteria for surgical repair of an AAA

Answer 34

>5.5cm must be repaired | below 5.5cm, risks of surgery outweigh the benefits

Question 35

Differentiating epigastric pain caused by GORD vs peptic ulcer disease

Answer 35

GORD pain would be worse when bending forward. Not so with PUD. Lack of acid reflux makes PUD less likely