Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
52 Cards in this Set
- Front
- Back
|
Name as Many Gastrointestinal Symptoms you may ask a patient?
|
Pain
Appetite/weight change Early Satiation Nausea/vomiting Heart burn (acid reflux) Waterbrash (excessive secretion of saliva) Dysphagia Change in bowel habit Bloating Pruritus Change in Urine, stool color Lethargy Fever |
|
|
What Characteristics of abdominal pain should you ask about? (or general presenting symptom)
|
Site/radiation
Quality Severity Onset Context Time course Aggravating/relieving factors Associated symptoms |
|
|
What is Colicky pain and what is the typical source of this type of pain?
|
Colicky pain is pain that comes and goes in waves, typically related to peristaltic movements. Generally the pain is a result of obstruction (bowels, ureters)
|
|
|
What is the typical characteristic of Pancreatic Pain?
|
Steady epigastric pain
Partially relieved by sitting up + leaning forwards Radiation to the back (although pain may radiate anywhere) Vomiting is common |
|
|
What is the typical characteristic of Peptic Ulcer pain?
|
Dull burning pain in epigastrium
Relieved to a degree by food or antacids Episodic, may wake patient up at night |
|
|
What is typical of biliary pain?
|
Epigastric pain which is severe and constant lasting hours
If cholecystitis develops, pain shifts to the right upper quadrant and becomes more severe (due to peritoneal involvement) Can be brought on after eating fatty meals |
|
|
What is the typical presentation of renal colic?
|
Colicky pain that is superimposed on a background of constant pain in the renal angle.
Can radiate to the groin |
|
|
What is the typical presentation of pain caused by bowel obstruction?
|
Colicky Pain
Peri-umbilical pain may suggest small bowel origin Colonic pain can occur anywhere in the abdomen Small bowel colics are more frequent (cycle every 2-3 mins) Large bowel colics are less frequent (cycle every 10-15 mins) Often associated with Vomiting, constipation and abdominal distention |
|
|
What combination of symptoms should make you suspect malignancy?
|
Anorexia (decreased appetite)
Weight loss |
|
|
In people with weight loss and increased appetite, what causes are likely?
|
Malabsorption
Hyper-metabolic states |
|
|
what is the timing and possible causes of vomiting?
|
>1 hour after a meal - gastric outlet obstruction
Early morning vomiting before eating - alcoholism, pregnancy, raised ICP |
|
|
What are the Types of Diarrhea (5 types/ causes)
|
1. Secretory diarrhea (likely if its of high volume i.e >1L/day and persists when the patient fasts)
2. Osmotic Diarrhea (disappearance with fasting, production of large volume stools on eating) 3. Abnormal Intestinal Motility 4. Exudative diarrhea (due to inflammation in the colon, stools of small volume but frequent, associated blood/mucus) 5. Malabsorption (usually due to steatorrhea) |
|
|
What is passage of bright red blood passed through the rectum called?
|
Haematochezia
|
|
|
what are possible structural sources of blood emission from the mouth?
|
Gums, Nose, Oesophagus, Stomach, Duodenum, Lungs, Trachea
|
|
|
How low should Hb be before a patient is Anaemic?
|
Generally its a Hb concentration of 70g/L or less
|
|
|
What are the signs of Liver Failure?
|
Hands: clubbing, leuconycia, palmer eythema, asterixis
Face: jaundice, scratch marks, spider naevi, fetor hepaticus Chest: Spider naevi, gynacomastia, loss of body hair, pectoral muscle wasting Abdomen: Portal hypertension, bruising, testicular atrophy Legs: Pedal oedema, wasting, bruising Fever (in 1/3 of patientswith advanced cirrhosis) |
|
|
What is the pathophysiology of Asterixis?
|
A.k.a. Hepatic flap is thought to be the result of interference with the inflow of joint position sense information to the reticular formation in the brainstem
Causes include: hepatic encephalopathy due to liver, cardiac, respiratory and renal failure and hypoglycemia, hypokalemia, hypomagnesemia or barbiturate intoxication. |
|
|
What is the pathophysiology of Palmer Erythema?
|
Reddening of the palms affecting the thenar and hypothenar eminences is caused by Liver failure. Although the cause was thought to be caused by raised estrogen levels, the exact mechanism is unknown
|
|
|
What is the mechanism of gynecomastia, testicular atrophy and spider naevi in Liver failure?
|
The liver normally breaks down estrogen. In a failing Liver, this function becomes less effective leading to a raised estrogen to testosterone level in the body.
|
|
|
What is koilonychia and what is usually associated with it?
|
Koilonychia is spooning of the nails. It is caused by hypochromic anaemia, especially due to Iron deficiency
|
|
|
What is abdominal rigidity and what does it usuallt indicate?
|
Rigidity is a constant involuntary contraction of the abdominal muscles (always asscociated with tenderness)
It Indicates Peritoneal Irritation |
|
|
What is the normal anatomical markings of the upper and lower borders of the liver?
|
Upper = 6th rib, midclavicular line
Lower = Just below right costal margin (on inspiration) |
|
|
What is Riedel's lobe?
|
It is a tongue like projection of the liver from the right lobes inferior surface
|
|
|
What is murphy's sign?
|
Positive if the patient takes a deep breath and catches his/her breath when and inflammed gallbladder presses on the examiners hand.
|
|
|
What is Courvoisier's law?
|
It states that if the gallbladder is enlarged and the patient is jaundiced, the cause is unlikely to be gallstones (gallbladder with stones is usually chronically fibrosed and therefore incapable of enlargement)
|
|
|
How do you tell apart a spleen and a kidney clinically?
|
Kidney can't be percussed (retroperitoneal so ressonant percussion note due to bowel gas)
Spleen has a notch Spleen moves with inferior medially with inspiration (while kidneys move inferiorly) Spleen has no palpable upper border |
|
|
How large must a spleen be before it is palpable?
|
1.5-2 times normal size
|
|
|
What are the anatomical markings of the spleen?
|
Right Posterior Auxillary Line
Lies behind 7-9th ribs |
|
|
When would a fluid thrill on abdominal examination be positive?
|
Ascites
Massive ovarian cyst Pregnancy with hydramnois |
|
|
What are the causes of Ascites?
|
Cirrhosis
Alcoholic Hepatitis Fulminant Hepatic Failure Congestive heart failure, constrictive pericarditis (Cardiac ascites) Budd-Chiari syndrome (hepatic vein thrombosis) Myxoedema Massive Liver metastases TB Pancreatic ascites Nephrotic syndrome |
|
|
Where do you ascultate to listen for bowel sounds? What do different sounds indicate?
|
Below the umbilicus
(there is little value in ascultating elsewhere) Absent bowel sounds for >4 mins is likely to be due to a paralytic ileus Obstructed bowel produces a higher pitched sound with "tinkling" quality (due to air) |
|
|
What are loud audible bowel sounds termed? what is this likely to be caused by?
|
Borborygmi
likely to be due to diarrheal states |
|
|
What type of hernia's are likely to strangulate bowel? What are the symptoms of strangulation?
|
Small hernias
Pain, Erythematous area lying just superior to the hernia, obstruction |
|
|
What is the DDx for:
- Severe abdominal pain - Rigidity of the entire abdominal wall and prostration |
Think retroperitoneal structures
- Perforated Peptic Ulcers - Perforation of other abdominal organs - Dissecting Aneurysm - Severe pancreatitis |
|
|
What is the DDx for:
Tenderness and rigidity in right hypochondrium |
Acute cholecystitis
Appendicitis (high appendix) Perforated duodenal ulcer Pleurisy Pneumonitis Subphrenic abscess Acute pyelonephritis Cholangitis |
|
|
What is the DDx for:
Tenderness and rigidity in left hypochondrium |
Pancreatitis
Subphrenic abscess Diverticulitis Ruptured spleen Acute pyelonephritis Leaking aneurysm of splenic artery Acute gastric distension |
|
|
What is the DDx for:
Tenderness and rigidity of the right iliac fossa |
Appendicitis
Ectopic pregnancy Perforated duodenal ulcer Crohns' disease or inflammed ileocecal glands Inflammed Merkel's diverticulum Cholecystitis with low gallbladder |
|
|
What is the DDx for:
Tenderness and rigidity in the Left iliac fossa |
Diverticulitis
Colitis Colonic cancer Pelvic peritonitis Ruptured ovarian cyst |
|
|
What is the DDx for:
Periumbilical pain without abdominal signs |
Acute mesenteric ischaemia/infarction
Acute appendicitis Acute small bowel obstruction Acute pancreatitis |
|
|
what are some Gynaecological causes of an acute abdomen?
|
Ectopic pregnancy
Torsion/haemorrhage of/into ovarian cyst Acute salpingitis Ruptured uterus |
|
|
What are good signs that indicate hepatocellular disease as a cause of jaundice?
|
Descending order of Positive LR
1.Distended abdominal veins 2.Palmer erythema 3.Spider naevi 4.Ascites 5.Palpable spleen |
|
|
What clinical features are strongly suggestive of cirrhosis?
|
Presence of 2 or more of the following
- Spider naevi - Palmer erythema - Spleenomegaly OR ascites - Abnormal collateral abdominal veins |
|
|
What are the signs of portal hypertension?
|
Spleenomegaly
Collateral Veins Ascites |
|
|
What are the causes (pre, intra and post sinusoidal) of portal hypertension?
|
Cirrhosis
Presinusoidal: portal vein compression, intravascular clotting (polycythemia), umbilical vein phlebitis Intrahepatic: Sarcoid, lymphoma, leukaemic infiltrates Post sinusoidal: Budd-Chiari syndrome, veno occlusive disease, contrictive pericarditis, chronic cardiac failure |
|
|
What are the signs to look out for when examining a patient complaining of dysphagia or odynophagia?
|
Weight loss (due to decreased food intake or cancer)
Koilonychia (can be associated with Plummer-vinson syndrome) Pallor on palmer creases Mouth ulcers, infection Lymphadenopathy in supraclavicular region Retrosternal thyroid enlargement Aspiration into lungs Hepatomegaly (secondary cancer deposits) Melaena |
|
|
What is Plummer-Vinson syndrome?
|
Iron deficiency anaemia + dysphagia due to upper oesophageal web (thin structure without muscle)
|
|
|
What are the signs of Malabsorption?
|
General: Wasting, loose skin folds, pallor (anaemia)
Stools: Steatorrhoea Mouth: Intraoral purpura (vit K deficiency, hyperkeratotic white patches (vit A deficiency) Limbs: Bruising (vit K), oedema (protein deficiency), peripheral neuropathy (vit B12, thiamin deficiency), bone pain (Vit D deficiency) |
|
|
What are the different types of malabsorption? (4 types)
|
Lipolytic phase defects: pancreatic enzyme deficiency (cystic fibrosis, chronic pancreatitis)
Micellar phase defects: Bile salt deficiency Mucosal defects: Diseased epithelial lining Delivery phase defects: Inability to transport fat out of cells into lymphatics (intestinal lymphangiectasia, carcinomatous infiltration of lymphatics) |
|
|
Which part of the bowel is effected by ulcerative colitis and crohns' disease
|
UC only effects the large bowel, but may effect the terminal ileum (backwash ileitis)
Crohns' Diseasen can effect the entire GI tract from the mouth to the anus. Most commonly effects the terminal ileum |
|
|
What are the signs and symptoms of Ulcerative Colitis?
|
Proctitis, tenderness and gaurding over effected colon, toxic dialatation (toxic megacolon which gives tachycardia, pyrexia, peritonism), Primary sclerosing cholangitis (leads to liver disease), anaemia, arthritis, erythema nodosum, pyoderma gangrenosum, apthous mouth ulcers, occular inflammation
|
|
|
What are the signs and symptoms of Crohns' Disease
|
Tenderness, fullness or mass in right iliac fossa may be present
Signs of abdominal abscess High swinging fever Evidence of bowel obstruction Dehydration skin tags, fistulas, fissures Gall and renal stone symptoms |
|
|
What are the signs and symptoms of bowel obstruction?
|
Pain
Vomiting Constipation Dehydration Abdominal distention Tenderness |
