the GI examination

Question 1

why is patient supine for GI examination

Answer 1

relaxes abdominal muscles

Question 2

jaudice is caused by

Answer 2

hyperbilirubinaemia

Question 3

telangiectasis

Answer 3

dilatation of capillaries causing them to appear as small red/purple clusters

Question 4

hereditary hearrhagic telangiactasia

Answer 4

telangiectasis in nail beds, palms, feet

GI bleedings

Question 5

pseudoxanthoma elasticum

Answer 5

yellow plagues/papules in flexural areas

bowel bleeding, ischaemia

Question 6

blue rubber bleb syndrome

Answer 6

haemangiomas eg. on the tongue

bleeding into bowel or liver

Question 7

inflammatory bowel disease

Answer 7

pyoderma gangrenosum 
eyrhtema nodosum 
clubbing 
mouth ulcers 
UC or chrons disease

Question 8

haemochromatosis

Answer 8

bronze skin pigmentation
hepatomegaly, signss of chronic liver disease
diabetes, heart failure, arthropathy, testicular atrophy

Question 9

systemic sclerosis

Answer 9

skin that it thick and bound down 
calcinosis 
raynauds phenomenon 
sclerodactyly 
telangiectases 
reflux, oesophageal dysmotility, small bowel bacterial overdose with malabrosption

Question 10

skin pigmentation in haemochromatosis

Answer 10

haemosiderin stimulating melanocytes to produce melanin

Question 11

addisonian type skin pigmantation

Answer 11

sun kissed pigmentation of the nipples, palmar creases, pressure areas and mouth

Question 12

peutz-jeghers syndrome

Answer 12

freckle like spots (discrete brown lesons) around the mouth and on the buccal mucosa
assocated with hemartomas of the small bowel which may cause bleeding intussusception
incidence of GI adenocarcinoma is increased

Question 13

acanthosis nigricans

Answer 13

brown to black velvety elevations of the epidermis due to confluent papillomas and are usually found in the axillae aand nape of the neck
associated rarely with GI carcinoma and lymphoma
associated with endocrinopathies

Question 14

lauchonychia

Answer 14

chronc liver disease results in hyperbilirubinaemia causing the nail beds to opacify

Question 15

clubbing in Gi exam

Answer 15

cirrhosis, inflammatory bowel disease, coeliac disease

Question 16

palmar erythema

Answer 16

liver palms
affecting thenar and hypethenar eminences
soles of the feet may also be affected

Question 17

anaemia

Answer 17

pallor of the palmar creases

may result from GI blood loss, malabsorbtion (folate, B12) haemolysis (hypersplenism), or chornic disease

Question 18

dupuytren’s contracture

Answer 18

palpable thickening and contraction of the palmar fascia causing permentn flecion
associated with alcoholism, found in manual workers, familial

Question 19

hepatic flap

Answer 19

asterixis
hepatic encephalopathy
absent at rest and brought on by sustained posture
can also occur in cardiac, respiratory and renal failure as well as hypoglycaemia, hypokalaemia, hypomagnesaemia or barbturate intoxication

Question 20

2 reasons for brusing

Answer 20

hepatocellular damage can interfere with protein synthesis for the production of clotting factors

obstructive jaundice results in a shortage of bile acids and reduced absorbtion of vit K which is vtal for the production of some clotting factors

Question 21

3 causes of petechiae

Answer 21

chronic excessive alcohol consumption causes bone marrow depletion causing thrombocytopenia
spenomegaly secondary to portal hypertension can cause hypersplenism resulting in excessive destruction of platelets in the spleen
in severe liver disease - DIC can occur

Question 22

scratch marks

Answer 22

due to severe itch
are often prominent in pateints with obstructive or cholestatic jaundice
commonly resenting feature in primary biliary cholaangitis

Question 23

spider naevi are found on

Answer 23

the areas usually drained by the superior vena cava

found on arms, neck and chest wall

Question 24

characteristic of spider naevi

Answer 24

occassionally bleed
presssure applied to the central arteriolle will cause blanching of the whole lesion
rapid reflling occurs on release of pressure

Question 25

causes of spider naevi

Answer 25

cirrhosis, frequently due to alcohol

Question 26

if a spider naevi does blanch

Answer 26

campbell de morgan spots - elevated and no dot blanch, common and benign venous stars - 2-3cm lesions, not blanched hereditary haemorrhagic telangiectasia - resemble spider naevi

Question 27

bitot's spots

Answer 27

yellow keratinised areas on the sclera severe vit A deficiency retinal damage and blindness may ensue

Question 28

kayser-fleischer rings

Answer 28

brownish green rings occuring at the periphery of the cornea, affecting the upper pole more thnaa the lower typically found in wilson's diseaase

Question 29

wilson's disease

Answer 29

copper storage disease that causes cirrhosiis and neurological disturbances kayser fleischer rings are usually present by the time neurological signs have appeared

Question 30

xanthalasmata

Answer 30

yellowish plaques in the subcutaneous tissues in the periorbital region and are due to deposits of lipids elevation of serum cholesterol common in patients with primary biliary cirrhosis in patinets with cholestasis, lipoprotein X in found in the plasma and is associated with elevation of serum cholesterol

Question 31

bilateral parotidomegaly

Answer 31

associated with alcoholism due to fatty infiltration may be mumps

Question 32

causes of fetor

Answer 32

- faulty oral hygiene - fetor hepaticus (a sweet smell) - ketosis (diabetic ketoacidosis results in excretion of ketones in exhaled air, causing a sickly sweet smell) - uraemia (fish breath: an ammoniacal odour) - alcohol - paraldehyde - putrid ( due to anaerobic chest infection with large amount of sputum) - cigarettes

Question 33

lingua nigra

Answer 33

black tongue due to accumulation of kerratin due to elongation of papillae over the posterior part of the tongue symptomless

Question 34

geographical tongue

Answer 34

slowly changing red rings and lones that occur over the surface of the tongue not painful

Question 35

leukoplakia

Answer 35

white coloured thickening of the mucosa premalignant may be caused by sore teeth, smoking, spirits, sepsis orr syphilis

Question 36

glossitis

Answer 36

``` smooth appearance of the tongue due to atrophy of the papillae may be shollow ulceration due to nutritional deficiency common in alcoholics ```

Question 37

macroglossia

Answer 37

may occur in congenital conditions such as downs syndrome or in endocrine disease, including acromegaly tumour infiltration or infiltration of the tongue with amyloid mateiral my be responsible

Question 38

aphthous ulceration

Answer 38

painful shallow ulcer | may occur in chrons or ulcerative colitis

Question 39

angular stomatitis

Answer 39

refers. to cracks at the corners of the mouth | vitamin deficiency

Question 40

gynaecomastia

Answer 40

may be unilateral or bilateral and the breasts may be tender may be a sign of chronic liver disease may be alcoholic cirrhosis or chronic autoimmune hepatitis

Question 41

patents with severe portal hypertension

Answer 41

portal to systemic flow occurss through the umbilical veins, which may become engorged and distended called caput medusae

Question 42

striae

Answer 42

pink linear marks with wrinkled appearance stretching of the abdominal wall severe enough to cause rupture of the elastic fibres in the skin usually pregnancy, recent weight gain may be cushings syndrome

Question 43

Answer 43

Question 44

features of intraabdominal masses

Answer 44

``` region involved tenderness size surface, regular or irregular edge consistancy - hard or soft mobility and movement with inspiraation whether it is pulsitile or not whethher one can get above the mass ```

Question 45

rigidity of the abdominal muscles

Answer 45

``` involuntry reflex (unlike guarding) tenderness and indicated peritoneal irritation or inflammation ```

Question 46

rebound tenderness

Answer 46

strongly suggests perintonitis

Question 47

how to feel for hepatomegaly

Answer 47

more your hand during expiration | wait during inspiration for the liver to come into contact

Question 48

describing the liver edge

Answer 48

hard or soft, tender or non tender, regular or irregular, pulsitile or non ppulsitile

Question 49

normal liver span in

Answer 49

<13cm

Question 50

massive hepatomegaly likely due to

Answer 50

``` right heart failure metastasis alcholic liver disease with fatty infiltration myeoloproliferative disease hepatocellular cancer ```

Question 51

moderate enlarged liver likely due to

Answer 51

haemochromatosis heamatological disease fatty liver infiltration

Question 52

mild hepatomegaly likely due to

Answer 52

hepatitis biliary obstruction hydatid disease HIv infection

Question 53

firm and irregular liver likely due to

Answer 53

hepatocellular carcinoma metastatic disease cirrhosis hydatid disease, grauloma, amyloid, cystsk lipoidoses

Question 54

tender liver causes

Answer 54

``` hepatitis rapid liver enlargement syndrome hepatocellular cancer hepatic abscess biliary obstruction cholangitis ```

Question 55

pulsitile liver

Answer 55

tricuspid regurgitation hepatocellular cancer vascular abnormalitlies

Question 56

causes of hepatosplenomegaly

Answer 56

``` chronic liver disease with portal hypertension haematologicla disease infection infiltration connective tissue disease acromegaly thyrotoxicosis ```

Question 57

types of infections causes hepatospenomegaly

Answer 57

acute viral hepatitis, infections mononucleiosus, cytomeglovirus

Question 58

kidneys with inspiration

Answer 58

move downward on inspiration