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GI and RS Signs
Clinical Signs and Symptoms of GI and Respiratory Pathology
| Sign/Symptom | Pathology |
|---|---|
| Cough of recent origin | Common cold, rhinitis, acute bronchitis, exacerbation of chronic bronchitis or pneumonia (especially if associated with fever) |
| Chronic cough | Asthma (+/- wheezing), COPD, bronchiectasis, cardiac failure, dry in oesophageal reflux and ACE inhibitors. |
| Cough with postnasal drip or headaches | Upper airway cough syndrome |
| Chronic cough with large amounts of purulent sputum | Bronchiectasis |
| Cough that is worse in the morning | COPD |
| Cough that is worse at night | Asthma |
| Small amounts of blood with sputum | Bronchitis |
| Frank blood, history of smoking, hoarseness | Bronchial carcinoma |
| Dyspnoea with wheeze | Aiway obstruction (COPD or asthma). |
| Dyspnoea of sudden onset | Pneumothorax |
| Asterixis | Respiratory: Severe COPD (CO2 retention) GIT: Early stage of chronic liver failure |
| Central cyanosis | COPD, pulmonary embolism, pneumonia |
| Stridor | Anaphylaxis, acute epiglottitis, inhaled foreign body, tumour |
| Clubbing | Respiratory Tract: Lung carcinoma, bronchiectasis, cystic fibrosis, asbestosis. GIT: Cirrhosis, inflammatory bowel disease, coeliac disease |
| Wasting of interosseous muscles and weakness of abduction | Compression of T1 nerve root (apical lung carcinoma) |
| Pulsus paradoxus and tachycardia | Severe asthma |
| Hypertrophic osteoarthropathy | Associated with clubbing - Lung carcinomas and pleural fibromas |
| Nasal polyps | Asthma |
| Engorged turbinates | Allergic conditions |
| Poor dentition | respiratory: Lung abscess, pneumonia GI: Fetor, ulcers |
| Plethora or cyanosis | SVC obstruction |
| Displacement of trachea towards affected side | Upper lobe fibrosis, atelectasis, pneumothorax |
| Displacement of trachea away from affected side | Massive pleural effusion, tension pneumothorax |
| Barrel chest | Severe asthma or emphysema (gas trapping) |
| Pigeon chest | Manifestation of chronic childhood respiratory illness (RSV) |
| Funnel chest | Developmental defect |
| Harrison's sulcus | Severe childhood asthma or rickets (vitamin D deficiency) |
| Kyphocoliosis | Poliomyelitis, Marfan's syndrome |
| Subcutaneous emphysema | Pneumothorax, rupture of oesophagus |
| Reduced chest wall expansion on one side | Lung fibrosis, consolidation, collpase, pleural effusion, pneumothorax |
| Bilateral reduction of chest wall expansion | COPD, diffuse interstitial lung disease |
| Paradoxical movement of chest | Diaphragmatic paralysis |
| Hoover's sign | COPD |
| Increased vocal resonance, fremitus and whispering pectoriloquy | Consolidation |
| Stony dull percussion | Pleural effusion |
| Hyper-resonant percussion | Bowel, pneumothorax, tension pneumothorax |
| Dull percussion | Consolidation, collapsed lung, liver (upper level of dullness at the 5th rib) |
| Bronchial breath sounds | Consolidation |
| Reduction of breath sounds | COPD (especially emphysema), pleural effusion, pneumothorax, pneumonia, large neoplasm and pulmonary collapse |
| High pitched wheezes | Asthma |
| Low-pitched wheezes | COPD |
| Localised, monophonic wheeze | Fixed bronchial obstruction (carcinoma of the lung) |
| Early-inspiratory crackles | COPD |
| Late-inspiratory crackles | Disease confined to alveoli eg. asbestosis |
| Coarse crackles | Bronchiectasis |
| Pleural friction rub | Pleurisy, pneumonia |
| Liver ptosis | Emphysema |
| Facial plethora, cyanosis,inspiratory stridor, elevated JVP | Positive Pemberton's sign - SVC obstruction |
| Peripheral oedema or cyanosis | Cor pulmonale |
| Reduced FEV1 and FVC with FEV1 being disproporitonately low. Reduced FEV1/FVC ratio | Obstructive ventilatory defect |
| Reduced FEV1 and FVC but increased or normal FEV1/FVC ratio | Restrictive ventilatory defect |
| Dull, burning pain in epigastrium that is relieved by foods or antacids. May wake the patient from sleep | Peptic ulcer disease |
| Steady epigastric pain that radiates to the back. Relieved by sitting forwards | Pancreatic pain |
| Severe, constant pain in the epigastrium that shift the right subcostal region. | Cholecystitis |
| Colicky pain in the renal angle that radiates to the groin. | Renal colic |
| Colicky pain with vomiting, constipation and abdominal distension | Bowel obstruction |
| Anorexia and weight loss | Malignancy, depression. |
| Weight loss and increased appetite | Thyrotoxicosis |
| Disturbance of taste | Liver disease |
| Early satiation | Peptic ulcer disease |
| Acute nausea | GIT infections, small bowel obstruction |
| Chronic nausea | Pregnancy, opiates, chemotherapy, alcoholism, gastric outlet obstruction, acute hepatobiliary disease |
| Heartburn and acid regurgitation | GORD, sliding hiatus herniation |
| Dysphagia for solids only | Mechanical obstruction - carcinoma, foreign body, mediastinal tumours |
| Dysphagia for solids and liquids | Neuromuscular - achalasia (progressive), diffuse oesophageal spasms |
| Odynophagia | Infective oesophagitis, peptic ulceration of oesophagus or oesophageal perforation |
| Constipation | Old age, bowel obstruction, codeine, hypothyroidism, pregnancy |
| Passage of mucus | Solitary rectal uler, fistula, IBS, villous adenoma |
| Haematemesis | Gastric ulcers, oesophageal varices, Mallory-Weiss tear (huge due to coughing or vomiting) |
| Maelena | Bleeding from oesophagus, duodenum or stomach, chronic peptic ulceration, right sided colonic bleeding. |
| Haemaochezia | Haemorrhoids, anal fissures |
| Pruritis | Cholestatic liver disease |
| Jaundice, painlessly distended gall bladder | Carcinoma of the head of the pancreas - Courvoiser's Sign |
| Freckle like spots around the mouth and in the oral mucosa | Peutz-Jeghers Syndrome - associated with hamartomatous polyps in colon |
| Generalised skin pigmentation | Haemochromatosis |
| Brown-black velvety elevtaions of the epidermis of the axilla. | Acanthosis nigricans - associated with GI carcinoma |
| Impaired mental state | Hepatic encephalopathy |
| Leuconychia | Hypoalbuminaemia - chronic liver or renal failure. |
| Palmar erythema | Chronic liver disease, pregnancy, thyrotoxicosis, rheumatoid arthritis |
| Pallor or palmar creases and/or conjunctiva | Anaemia - GI blood bloss, malabsorption (folate or B12) or haemolysis (hypersplenism) |
| Ecchymoses | Clotting abnormalities, obstructive jaundice |
| Petechiae | Chronic excessive alcohol consumption, splenomegaly caused by portal hypertension |
| Spider naevi | Cirrhosis, viral hepatitis, pregnancy |
| Yellow sclera | Hyperbilirubinaemia |
| Kayse-Fleisher rings | Wilson's disease |
| Xanthelasma | Hypercholesterolaemia |
| Bilateral parotid enlargement | Alcoholism |
| Unilateral parotid enlargement | Parotid carcinoma, mumps |
| Fetor hepaticus | Severe hepatocellular disease, precomatose condition |
| Leucoplakia | Poor dental hygiene, smoking, alcohol, sepsis, syphilis |
| Glossitis | Deficiences of folate, B12, alcoholism |
| Apthous ulceration | Crohn's disease, Coeliac disease |
| Angular stomatis (cracks at the corners of the mouth) | Deficiences of vitamin B6, B12, folate or iron |
| Candidiasis | Broad spectrum antibiotics, faulty oral hygeinei, iron deficiency, diabetes mellitus |
| Enlarged left supraclavicular node (Virchow's node) | Gastric cancer |
| Gynaecomastia and hair loss | Chronic liver failure, cirrhosis, alcoholism |
| Bulging region of abdomen when patient coughs | Herniation |
| Abdominal distension | Food, faeces, foetus, flatus, tumour or phantom pregnancy |
| Prominent veins - Caput Medusae | Portal hypertension or IVC obstruction |
| Visible peristalsis | Pyloric obstruction |
| Bluish tinge to umbilicus | Cullen's sign - acute haemorrhagic pancreatitis or severe haemaperitoneum |
| Striae | Cushing's syndrome, pregnancy, ascites |
| Guarding, rigidity, rebound tenderness, cross tenderness, pain on coughing, pain on straight leg raising | Peritonitis |
| Murphy's sign | Cholecystitis |
| Hepatomegaly | Metastases, alcoholic liver disease, right heart falure, hepatocellular cancer, haemochromatosis, bilairy obstruction, hepatitis |
| Epigastric pain | Myocardial infarction, peptic ulcer, pancreatitis, biliary colic |
| Left upper quadrant pain | Spleen, renal colic, diverticulitis |
| Periumbilical pain | Irritable bowel disease, ischaemic bowel disease, ruptured AAA, appendicits, gastroenteritis |
| Left lower quadrant pain | Ovarian, ruptured ectopic pregnancy |
| Right lower quadrant pain | Ovarian, appendicitis, ruptured ectopic pregnancy |
| Right upper quadrant pain | Biliary colic, hepatitis, renal colic, diverticulitis |
| Hepatosplenomegaly | Portal hypertension with chronic liver disease, acute viral hepatitis, sarcoidosis, leukaemia |
| Enlarged kidneys | Renal cell carcinoma, polycystic kidney disease, infiltrative disease |
| Palpable, distended bladder | Urinary retention |
| Arterial pulsations > 5cm apart | AAA |
| Dullness on inspiration of spleen | Splenomegaly |
| Suprapubic dullness | Enlarged bladder or pelvic mass |
| Dull percussion of flanks which becomes resonant when patient rolled onto one side | Acites -shifting dullness |
| Loss of liver dullness | Massive hepatic necrosis, perforated bowel |
| High pitched 'tinkling' bowel sounds | Bowel obstruction |
| Absent bowel sounds over 4 minutes | Paralytic ileus |
| Borboryogmi | Diarrhoea |
| Hepatic friction rub | Tumour within the liver, liver abscess, recent liver biopsy, liver infarct |
| Splenic friction rub | Splenic infarct |
| Venous hum | Intrahepatic portal hypertension |
| Renal artery bruits | Renal artery stenosis |
| Steatorrhoea | Malabsorption of fat, severe pancreatic disease |
| Colorectal cancer (rectum) | Fresh blood with faeces |
| Colorectal cancer (left colon) | Tenesmus, faecal urgency, constipation, rectal bleeding |
| Colorectal cancer (right colon) | Usually asymptomatic until systemic features (weight loss, anaemia, fatgiue) |
| Abdominal fullness, vomiting, problems with absorption and digestion in diabetic patients | Gastroparesis due to neuropathy |
| Intermittent dysphagia, regurgitation, a sense of food being stuck in the oesophagus and chest pain | Achalasia (aperistalsis) |
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