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PAEDIATRICS > Abdominal exam and diarrhea > Flashcards

Abdominal exam and diarrhea Flashcards

1
Q

State 5 causes of abdominal distension

A

Fat, faeces, gas,fluid
Hypotonic abdominal muscles resulting in protuberant abdomen
Visceromegaly- liver spleen
Exaggerated lordosis

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2
Q

State 3 causes of splenomegaly under increased activity

A

Increased degradation of cells
Increased immune response
Compensatory extramedullary hematopoiesis by spleen

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3
Q

State 3 purposes of an abdominal exam

A

To seek abdominal masses and fluid
To detect enlargement of abdominal organs
To seek the presence of normal abdominal structures

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4
Q

State 4 characteristics of the liver

A

Dullness to percussion
Movement with respirations
Unable to get above it because it grows upwards
A palpable edge in the right hypochondrium

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5
Q

State 3 kidney characteristics

A

Able to go above it
Moves on respiration
Has a smooth outline

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6
Q

State 4 spleen characteristics

A

Moves with respirations when enlarged
Able to go above it
Dull to percussion
Has a notch

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7
Q

State 4 unilateral kidney diseases

A

Congenital mesonephroma - Wilms
Renal vein thrombosis
Multicystic dysplasia
Hydronephrosis

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8
Q

State 3 causes of bilateral kidney diseases

A

Polycystic kidney disease
Congenital nephrotic syndrome
Bilateral obstructive uropathy secondary to posterior urethral valves

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9
Q

Causes of ascites in newborn babies x5

A

Biliary rupture of common bile duct
Chylous rupture of lymphatic duct
Urinary rupture of bladder
An exudate in peritonitis
A transudate in hydrops or heart failure

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10
Q

State 4 things you inspect on rectal exam

A

Protruding polyps
Threadworms
Anal fissures
Skin tags

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11
Q

State the causes of different bowel sounds x3

A

Absent- paralytic ileus
Hyperactive- normal, GE, Upper GI bleeding
Intense and tingling- mechanical obstruction

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12
Q

Define secretory diarrhea

A

Water and electrolytes excreted into the intestines after toxin stimulation > overwhelmed absorptive capacity of the colon

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13
Q

Define osmotic diarrhea

A

Unabsorbed nutrient and solutes create an osmotic gradient which draws water into the lumen

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14
Q

State the 3 main forms of diarrhea

A

Acute watery - hours to days
Dysentery - nutrient loss
Persistent >14 days

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15
Q

State why young children are more vulnerable to dehydration x4

A

Malnutrition
Higher metabolic rates
Kidneys less able to conserve water
Water constitutes a greater proportion of the body weight

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16
Q

Diarrhea prevention in children x2

A

Prevent exposure to pathogens through wash
Make the child less susceptible by immunizations and adequate nutrition

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17
Q

3 ways to obtain safe water

A

Treating water at the source
Treating household water
Storing water safely

18
Q

Ways of making the child less susceptible to diarrhea x3

A

Immunizations
Adequate nutrition
Micronutrient supplementation

19
Q

3 ways in which repeated diarrhea bouts worsen nutritional status

A

Decreased food intake
Reduced nutrient absorption
Increased nutritional requirements

20
Q

Effect of zinc on diarrhea x3

A

Reduction in recurrence
Reduction in duration of acute diarrhea
Reduction in treatment failure and death in persistent diarrhea

21
Q

Clinical signs of some dehydration x5

A

Sunken eyes
Restlessness
Irritable
Drinks eagerly
Skin pinch which goes back slowly

22
Q

Clinical signs of severe dehydration x5

A

Lethargic
Unconscious
Sunken eyes
Unable to drink
Skin pinch goes back very slowly

23
Q

State 4 things to assess in physical examination of a patient with diarrhea

A

Assess for
1. Danger signs- shock
2. Severe malnutrition
3. Hydration
4. Abdominal surgical problems

24
Q

State the most common cause of dysentery and the associated symptoms x4

A

Shigella
Abdominal pains, fever, lethargy and dehydration

25
Q

State 4 species of dysentery

A

S. dysenteriae
S flexneri
S boydii
S.sonnei

26
Q

State the classical triad of Hemolytic uremic syndrome HUS

A

Hemolytic anemia
Acute kidney injury
Thrombocytopenia- low platelet count

27
Q

Why does ORS work

A

It delivers sodium and glucose to the small intestines which are co transported into cells and water follows by osmosis due to gradient created

28
Q

Describe the effect of too much glucose and sodium in ORS

A

Glucose- increased osmotic load which can worsen diarrhea
Sodium- no organic solute for transport resulting in hypernatremia or worsening of diarrhea

29
Q

State 5 predisposing factors of persistent diarrhea

A

Poverty
Poor hygiene
Early weaning
Prolonged fasting
Micronutrient deficiency

30
Q

Describe mechanisms that cause development of persistent diarrhea x4

A

1.Use of antibiotics wipes away normal flora
2.Lactose intolerance - acute diarrhea cause villus damage where lactase enzyme is present
3.Some pathogens dampen host immune response and delay clearance
4.Host factors- immunosuppression, micronutrient deficiency

31
Q

Causes of diarrhea in HIV x4

A

ARTs
GI infections
GI manifestations of TB
HIV related malabsorption

32
Q

3 key features of diarrhea treatment

A

Zinc supplementation
Continued feeding
Oral rehydration therapy

33
Q

Non infectious etiologies of persistent diarrhea x4

A

Malabsorption
Celiac disease
Irritable bowel syndrome
Inflammatory bowel disease

34
Q

State 4 causes of malabsorption

A

Mucosal malabsorption
Bile acid insufficiency
Pancreatic exocrine insufficiency
Lactose intolerance

35
Q

Define ulcerative colitis and crohns disease

A

Ulcerative- inflammation of the mucosal layer of the colon
Crohns- transmural inflammation of any part of GI tract

36
Q

GI manifestations of IBD x5

A

Chronic relapsing and remitting diarrhea
Abdominal pain and tenesmus
Strictures fistulas and perianal skin tags

37
Q

Define IBS

A

Chronic recurrent abdominal pain and altered bowel habits without underlying organic disease

38
Q

Celiac disease

A

Gluten sensitive disease which results in immune mediated mucosal inflammation of the proximal small intestines > malabsorption

39
Q

Clinical manifestations of celiac diseases x5

A

Rash, weight loss
Iron deficiency anemia
Neurobehavioral symptoms
Chronic diarrhea, abdominal pain

40
Q

4 groups that get empiric antibiotics in diarrhea

A

Infants <3m
Preterm babies up to 52 weeks
Suspected shigella infection
Patient with concern for sepsis

41
Q

When do you suspect cholera x3

A

Children >2years
Profuse watery diarrhea
Signs of severe dehydration and shock

42
Q

Management of cholera and how it works x2

A

Azithromycin: 20mg/kg single dose
Erythromycin: 2.5mg/kg for three days
It shortens disease and reduce infectivity

PAEDIATRICS (20 decks)

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