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GI and RS Signs

Clinical Signs and Symptoms of GI and Respiratory 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)
Created by: Epoot