Abdo Exam Flashcards
Clinical manifestations of chronic liver failure
Clubbing
Gynaecomastia
Palmar erythema
Dupytrens contractures
Bruising
Petechia
Spider naevi
Leuconychia
Palmar pallor (also in GUT blood loss)
Features of kidney disease
HPT
Rickets (vitamin D hydroxylation)
Pallor
Role of vitamin A and Signs of vit A deficiency
Xerophthalmia, Bitot’s spots and keratomalacia
Vit A is important for:
-Vision
-Immune system
- Reproduction
-Growth and development
Role of vitamin B
Supports brain and nervous system
Role of vitamin C
It helps the body make collagen, to make skin, cartilage, tendons, ligaments, and blood vessels. Vitamin C is needed for healing wounds, and for repairing and maintaining bones and teeth.
Role of Vitamin D
Bone mineralisation
promotes calcium absorption in the gut and maintains adequate serum calcium and phosphate concentrations to enable normal bone mineralization and to prevent hypocalcemic tetany (involuntary contraction of muscles, leading to cramps and spasms)
Role of vitamin E
Prevents diseases, functions as an antioxidant, its role in anti-inflammatory processes, its inhibition of platelet aggregation and its immune-enhancing activity.
-deficiency results in neuropathy and haemolytic anaemia
Role of vitamin K
helps to make various proteins that are needed for blood clotting and the building of bones
Causes of an inlarged liver (and or spleen)
Infectious :
Hepatitis
HIV
Disseminated TB
Malaria (spleen)
Obstructive:
Biliary atresia
Choledochal cyst
Infiltration
Leukaemia
Lymphoma (petechia, lymphadenopathy)
CLD with portal HPT
Storage disorders
Cardiac (CCF, IE)
Direction of flow of blood from umbilicus in IVC obstruction and in portal HPT
IVC obstruction: towards umbulicus going up
Portal HPT: away from umbilicus going out in all directions from centre
Primary prevention for diarrhoea
Water supply
Sanitation
Hygiene
Vit A supplement
Zinc supplement
Rotavirus vaccines
Signs of some dehydration vs severe dehydration
Some dehydration
Lethargic or unconscious
Unable to or drinks poorly
Skin pinch goes back slowly
Sunken eyes
Vs
Severe dehydration
Irritable or restless
Drinks eagerly
Skin pinch goes back slow
Sunken eyes
Difine
Acute diarrhoea
Persistent diarrhoea
Chronic diarrhoea
Acute is =/<2 weeks
Persistent is =/>2weeks
Chronic is =/>3months
Indications for admission in a gastrointestinal patient (vomiting or diarrhoea)
• Shock
• Severe dehydration
• Neurological abnormalities
(lethargy, seizures, etc.)
• Intractable vomiting ORS treatment failure
• Caregivers cannot provide adequate care at home
• and/or there are social or logistical concerns
• Suspected surgical condition(not diarrhoeal disease!)
Contraindications to ORS rapid rehydration
Or
Which patients need slow rehydration
- Severe malnutrition
- Encephalopathy (eg hypernatremia, decreased LOC)
- <3 months or >5 years
- . Cardiac patient and Severe pneumonia
Outline the doses for slow rehydration
• Maintenance fluids:
– <3months: 150ml/kg/day
– 3m-1 year: 120/kg/day
– >1year: 1st 10 kg bodyweight:100ml/kg
- 2nd 10kg weight: add 50ml/kg
- >20kg weight: add 20ml/kg
(4:2:1 rule for >1yr)
Rehydration fluids:
5% dehydrated give 50ml/kg/day extra
10% dehydrated give 100ml/kg/day extra
Ongoing losses
30 ml/kg/day starting point OR 10ml/kg/stool
• Add the 3 volumes and divide by 24 to give mls/hour rate
• REVIEW!!! 6hourly weight checks- good guide on how things are going
Danger signs in a child that is vomiting
Bile stained or faeculent
Blood Stained
Projectile
Dehydration
Weight loss
Acid base abnormalities
Signs of intestinal obstruction
Fever or sign of systemic infection
CNS sx eg Headache, drowsiness
Early morning vomiting is a feature of which pathology
Raised ICP
What is secretory diarrhoea
Diarrhoea from increased Secretion of water and electrolytes induced by stimuli such as bacteria toxins (vibrio cholera, EColi) viral proteins (rotavirus) or hormones (VIP)
What is the most common cause of exocrine pancreatic insufficiency in children
Cystic fibrosis
How to calculate faecal osmolar gap
280-(2*(Na+K))
If less than 50, secretory
If more, Osmotic
What does a low stool pH mean
Carbohydrate malabsorption
Most common diarrhoea causing virus
Rotavirus
Complications of acute diarrhoea disease
- Dehydration
- Shock
- Electrolyte abnormalities:
-Hypernatremia/hyponatremia
-Hypokalemia
-Hypocalcemia
-Hypomagnesemia - Hypoglycemia
- Renal failure
- Haemolytic uremic syndrome
- Rhabdomyolysis
- CNS abnormalities: -Convulsions
-venous sinus thrombosis
Which drugs have anti-secretory properties and can be used in secretory diarrhoea
Octreotide
Somatostatin analogue
What advice would you give to a parent on discharge of a child who was treated for diarrhoea
Must F/U at local clinic 2dats after discharge for weight and wellbeing check
How to prepare ORS correctly
Give extra fluid for ongoing diarrhoea
To continue feeding
Return immediately if danger signs occur
Which org causes Travellers diarrhoea
Campylobacter jejuni
-main cause of intestinal disease/diarrhea
Complications of this type of diarrhea causing organism include Erythema nodosum, reactive arthritis and thrombocytopenia
Yersinia Enterocolitica
Type of diarrhea in which there is profuse diarrhea plus vomiting without nausea
Cholera
Diarrhea with rice water appearance
Vibrio cholera
Management of vibrio cholera diarrhea
. Observe enteric precautions.
◆ Rapid fluid replacement and rehydration. Intravenous rehydration is required in
children with circulatory collapse, continued vomiting or severe dehydration.
◆ The routine use of antibiotics in the treatment of cholera is not recommended. They are,
however, given to patients with severe dehydration as they shorten the duration of diarrhoea. The choice of antibiotics is guided by local resistance patterns. In South Africa a three day course of ciprofloxacin is given to children under the age of eight years and tetracycline to children over the age of eight years. These guidelines are regularly reviewed according to local resistance patterns and clinicians need to familiarise themselves with local recommendations.
◆ Strict input/output charting, frequent blood pressure readings, and serum urea and electrolyte measurements are necessary.
Which type of shigella aero group is most common in SA
Shigella Flexneri
Which presenting features will make you highly suspicious of the diagnosis of Cystic fibrosis in an abdo pt
Neonatal intestinal obstruction or neonatal obstructive jaundice
Poor growth despite adequate intake
Steatorrhoea
Recurrent chest infections especially with S. aureus or Pseudomonas, bronchiectasis hypochloraemic metabolic alkalosis
Rectal prolapse
Nasal polyps with or without a positive family history.
What tests confirm the dx of cystic fibrosis
Sweat test: Abnormally elevated sweat chloride
Homozygous for two CFTR mutations
Screening
-sweat conductivity or by detecting low faecal elestase levels
Management of cystic fibrosis
Pancreatic enzyme replacement therapy
Aggressive Nutritional support and,
Fat soluble vitamin supplementation
MDT referral (pulmonologist, gastro, physio, dietitian, social worker)
When to suspect organic cause of constipation
Delayed meconium and abnormal bowel movement s (Hirschsprung)
Explosive bowel after exam
Occult blood in stool
Failure to thrive, distended and obstructed
Thyromegaly
Lumbosacral area or perineum abnormalities
Abnormal neurological findings
Major cause of gastritis in children
Helicobacter pylori
Treatment of helicobavter pylori
Triple therapy
-PPIs
-2 Ab (clarithromycin or amoxicillin or metronidazole ) for 14days
Differentiate between coeliac disease and IBS
Coeliac disease is immune mediated enterooathy triggered by ingestion of gluten (wheat, oats, rye, barley) in susceptible people. T cell response leads to proximal small intestinal mucosa injury. Clinical presentation FTT, chronic diarrhea, abdo distension, wasting and ooor appetite after gluten containing meals. Ass with DM tyoe1, IgA def, Trisomy21, autoimmune dx.
Tx: gluten free diet.
IBS is a heterogeneous grouo of disorders in which ulcerative colitis and Crohns are major forms. Sx includes abdo pain, anorexia, weight loss, diarrhoea and blood in the stool
Is Hirschsprung’s ass with hypo or hyperthyroidism
Hypothyroidism
Difference between ulcerative colitis and crohns
Crohn’s disease involves any part of the gastrointestinal tract, with involvement of the terminal ileum and colon being the most common. Involvement is segmental with disease-free areas between the involved mucosa. Important complications include fistula formation (including peri-anal fistula) and intestinal strictures.
Ulcerative colitis involves inflammation of the colon and rectum . Involvement of the colon is continuous, extending from the rectum proximally for a varying length. Genetic factors, and environmental eg diet, breastfeeding.
Outline the grading system for ulcerative colitis
- Mild disease: <4 stools/day with or without blood
-mild abdo pain and cramps
-tenesmus (feeling you need to poop with empty bowel)
-no systemic toxicity
-normal ESR - Moderate: >4 stools/day.
-moderate abdo pain and cramps
-Minimal toxicity
-anaemia not requiring transfusion
-low grade fever - Severe disease>6 stools
-evidence of toxicity
-fever, tachycardia
-anaemia
-elevated ESR - Fulminant disease
>10 stools/day with continuous bleeding
-abdo tenderness and distension
-toxicity
-anaemia req transfusion
-colonic dilation
-toxic megacolon
-colonic perforation
Extraintestinal manifestatiosn of IBS (Clin signs)
Clubbing
Aphthous ulcers of mouth
Seronegative arthritis
Erythema nodusum
Autoimmune haemolytic anaemia
DVT and PE
Sacroiliitis
Ankylosis spondylitis.
How would you dx IBS and what are some of the advantages of that diagnostic modality
. Colonoscopy can be helpful when single-contrast barium
enema has not been informative in evaluating a colonic
lesion.
Useful in obtaining biopsy tissue, which helps in the
differentiation of other diseases, in the evaluation of mass
lesions, and in the performance of cancer surveillance.
Colonoscopy also enables dilation of fibrotic strictures in
patients with long-standing disease.
Postoperative period to evaluate surgical anastomoses to
predict the likelihood of clinical relapse as well as the
response to postoperative therapy.
Effects of steroids as Maintainance therapy in Crohn (for the inflammation)
Not indicated due to serious complications such as aseptic necrosis of the hip, osteoporosis, cataract, diabetes, and hypertension.
Withdrawal steroid once remission achieved
Indications for surgery in crohn
Persistent symptoms despite high dose corticosteroids
Tx related complications including intraabdominal abscesse
Medically intractable fistulae
Fibrotic strictures with obstructive symptoms
Intractable haemorrhage
Perforation
Cancer
Toxic mega colon
