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66 Cards in this Set
- Front
- Back
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What to look for at a general GI inspection?
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1. body bass (eg. obeisity, weight loss)
2. hydration 3. pyrexia 4. distress/pain 5. muscle wasting |
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What do you look for in the hands during a general GI inspection?
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1. Clubbing
2. cleanliness 3. leukonychia 4. palmar erythema 5. koilinychia 6. check pulse/BP |
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What can finger clubbing indicate?
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1. septic lungs (bronchiachstasis, TB)
2. malignancy (large cell lung cancer) 3. interstitial lung disease 1. any cardiac disease featuring chronic hypoxia 2. atrial myxoma 3. subacute endocarditis 4. congenital cyanoitc HD 1. Malabsorption 2. IBD 3. Cirrhosis (esp. Primary Biliary Cirrhosis 1. Hyperthyroidism 2. Unilateral Clubbing think axillary artery anuerysm |
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What can palmar eyrthema indicate?
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1. liver failure
2. pregnancy 3. thryotoxicosis 4. Rheum. Arth. |
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What do you look for in the face of a general GI examination?
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1. Pallor
2. Jaundice 3. Parotid swelling 4. angular stomatitis 5. Conjunctival pallor/jaundice 6. Glossitis |
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What can glossitis indicate?
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1. iron def. anemia, pernicious anemia and other B vits,
2. erythema multiform 3. Bacterial/Viral Infection |
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After inspection of the face what do you look for?
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Lymphadenopathy (look for trossiers sign in left supraclavicular nodes)
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What do you look for during inspection of the abdomen?
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1. spider nevie
2. scars 3. swellings 4. drains 5. stomas 6. distension 7. caput medusa |
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What is the differential If an individual is experiencing weight loss with a normal to high caloric intake?
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1. Type 1 Diabetes
2. hyperthyroidism 3. malabsorption 4. fever |
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What is the cause of rapid weight loss of more than .5 Kg per day?
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1. think fluid loss
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What GI malignancies can cause weight loss?
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1. Upper GI
2. Liver/Pancreas 3. Late presentation of Colon Cancer |
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What are the causes of liver failure anorexia?
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1. decreased caloric intake from anorexia, acitis and rest. on salt.
2. malabsoprtion of food from decreased bile production 3. decrease in metabolism of absorb nutrients |
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What does dysguesia maen?
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Altered taste sensation
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What is odynophagia?
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Pain on swallowing
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What are the causes of dysphagia?
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1. Mouth: painful ulcers, poor dentures mouth/throat infection
2. brain stem: CVA, bulbar palsy 3. Esophagus: Esophageal cancer, benign stricture, pharyngeal puch, alachasia 4. OTHER: mysthenia gravis, extrinsic pressure from lymphnodes/lung cancer |
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What is alachasia?
What is a complication and what is there an increased risk of? |
1. Failure of lower esophageal sphincter to relax leading to dilation
2. Aspiration pneumonia 3. esophageal cancer |
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What are the causes of odynophagia?
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1. peptic esophagitis
2. esophageal candidiasis |
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What questions can you ask to differentiate between heart burn and angina?
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1. sour taste?
2. Water Brash? 3. worse when lying down/bending 4. does it related with activity (angina) |
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What is dyspepsia?
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1. Pain or discomfort in the upper abdomen
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If there is an upper GI obstruction, what occurs when it is more distal?
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1. if distal to pylorus then more discomfort and green tinged vommit
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What are the autonomic features of vommitting?
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1. sweating
2. palor 3. hyperventalation |
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What are the ailimentery causes of vommiting?
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1. gastroenteritis
2. cholecystitis 3. pancreatitis 4. hepatitis |
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What are the neurological causes of vommiting?
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1. raised ICP
2. middle ear |
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What metabolic/endocrine problems cause vommitting?
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1. PREG
2. DKA 3. URAEMIA 4. HYPERCALCEMIA 5. Addison's Disease |
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What psychological factors cause vommitting?
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1. anorexia nervosa
2. bulemia 3. rummination |
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When blood is not vommited but wells up, what is the cause?
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1. bleeding is above the gastro-esophageal sphincter (e.g. varacies)
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What is a Mallory-Weis Tear?
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1. esophageal tear due to wretching, causes blood after initial vommit.
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How do you clinically assess volume loss?
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1. lightheaded
2. dizzy/fainting 3. tachycardia 4. hypotension |
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What is the differential for Hematemisis/Upper GI bleeding?
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1. Gastric Ulcer
2. Duodenal Ulcer 3. Esophageal varacies 4. Mallory-Weis Tear 5. Nose Bleeds 6. Esophagitis/Gastritis/Duodenitis 7. Esophageal/gastric cancer 8. Vascular Malformation |
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What is the most common cause of Hematemisis?
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1. Peptic ulcer
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How does alcohol cause hematemisis?
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1. acute gastritis/mallory weis tear
2. esophageal varacies |
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What sympathetics innervate abdominal vicera for pain?
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1. T5-L2
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Where is unpaired visceral pain felt?
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1. in the midline
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Where is forgut pain felt?
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1. above the umbilicus
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Where is pain for the small intestine felt?
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1. periumbilical
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What causes testicular pain?
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1. testicular tortion
2. epidiimo-orchitis (clap/gon/e.coli) |
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For GI pain what questions are important to ask?
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1. Site/Radiation
2. Type/Severity 3. Duration/Onset 4. Aggravating factors 5. Relieving factors 6. Associated symptoms |
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What is typical of peptic ulcer pain?
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1. Epigastric radiating to back
2. gnawing in character/mild to moderate 3. .5-2h, remmision for weeks/months 4. spicy foods/alcohol 5. antacids |
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What is typical of biliary colic pain?
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1. epigastric/right hypochondirum to right scapula
2. constant/severe pain 4-24 hours 3. unpredictable 4. unable to eat 5. Restless/vommitting/nasea/jaundice |
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What is typical of acute pancreatitis?
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1. epigastrum/left hypochondrium pain into back/generalised
2. constant severe pain less than 24 hours 3. unpredictable 4. agg.by alcohol 5. eased by sitting up right 6. Vommiting Jaundice. paralytic ileus |
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What are the Causes of Acute Pancreatitis?
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Gall Stones
Ethanol Trauma Steroids Mumps Auto Immune Scorpian Bite Hypercalcemia/lipidemia Drugs (sulfa) |
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What are the characteristics of renal pain?
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1. loin/flank into gentil inner thigh
2. constant/small fluctuations 3. severe/4-24 horus. discrete episode 4. agg. by dehyrdation 5. assoc with restlessness/vommitting/haematuria/dysuria |
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What can the nature of abdominal pain tell you?
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1. constant pain from solid organ
2. colicky pain from hollow organs |
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What can the speed of onset tell you about abdo pain?
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1. if severe and sudden indicates a perforation of hollow viscus, A.A.A., Mesentartic infarction
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If severe and sudden pain is preceeded by constipation what can this indicate? Dyspepsia? Co-Existiing vascular disease?
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1. Cancer/Diverticular Disease
2. peptic ulcer perforation 3. A.A.A/mesenteric infarction THINK TORSION OF ORGAN (OVARY/TESTIS) |
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If the pain is slower in onset what might this indicate?
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1. Inflammatory disorder (acute cholecystitis, apendicitis, diverticular disease)
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What is the silent interval?
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1. When a perforation is in between chemical peritonitis and bacterial peritonitis
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Pain associated with IBS, Diverticular disease and colorectal cancer is associated with what?
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Change in bowel habbit
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What is the differential for excessive flatulance?
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1. aerophagy
2. lactase def. 3. malabsorption |
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What are the causes of abdominal distension?
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Fat
Flatus (obstruction, pseudo obstruction) Faeces -Subacte obstruction, constipation Fluid -Ovarian/uterine mass/bladder/ascitis Fetus |
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What are the common, less common and rare causes of ascitis?
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1. Hepatic cirrhosis/intra-abdominal malignancy with peritoneal spread
2. nephrotic syndrome/right sided HF/constrictive pericarditis 3. Budd Chiari Syndrome, TB Peritonitis, Hypoprotenemia (enteropathy) or kawarshoirkor |
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What are the casues of constipation?
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1. dec. Fibre
2. IBS 3. Internal obstruction (cancer) 4. hypothyroidism/hypercalcemia 5. opiods/iron pils 6. immobility from CVA/Parkinsons |
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What questions should one ask a constipated patient?
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1. Life long/recent?
2. How often a week 3. how much time do you spend straining? 4. abdo pain before or during and rectal bleeding? 5. Shape of stool 6. Change in drug therapy? |
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What are the two types of diarrhea?
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1. Secretory
2. Osmotic |
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What are the causes of Secretory diarrhea?
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1. inflammation --> IBD, Viral or bacterial infection
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What are the causes of osmotic Diarrhea?
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1. malabsorption
2. drugs 3. motility disorder |
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What are the causes of acute diarrhea?
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1. infective gastro-enteritis
2. Drugs-antibiotics |
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What are some of the causes of chronic diarrhea?
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1. IBS
2. IBD 3. malabsorption 4. Colorectal cancer 5. Diabetes and autonomic neuropathy 6. laxative/drug abuse 7. Hyperthyroidism 8. Parasitic infection |
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If rectal bleeding is fresh and accompainied by shock what could it be?
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1. a brisk or massive upper GI bleed
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What are the causes of fresh rectal bleeding?
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1. haemmorhoids
2. anal fissure 3. colocrectal polyps 4. IBD 5 Ischemic colitis 6diverticular disease 7 vascular malformation 8 colorectal cacner |
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What is acholuric Jaundice?
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1. Jaundice that is accompanied by no change in urine colour indicating that it is pre-hepatic jaundice
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What are the causes of pre-hepatic jaundice?
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1. Gilbert's Syndrome (def. in gluconoryl transferase)
2. hemolysis (associated with anemia) |
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What type of bilirubin are found in Hepatocellular Jaundice? What are the causes of Hepatocellular Jaundice?
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1. Conjugated and Unconjugated
2. Viral hepatitis b. drugs c. autoimmune hepatitis d. cirrhosis |
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What are the causes of obstructive jaundice?
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1. primary biliary cirrhosis
2. drugs 3. primary sclerosis cholangitis 4. gall stone obstruction |
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In hepatocellular Jaundice what is found in urinalsysis?
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1. high bilirubin (dark urine)
2. contains urobilinogen (because conjugated by liver and allowed to absorbed by gut) |
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In Obstructive jaundice what is found on urinalysis?
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1. dark urin from bilirubin but no urobilin or urobilinogen
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