Gastrointestinal exam Flashcards
Portal hypertension
causes
HEPATIC
- cirrhosis from cholestatic disease: BA, PSC, CF, intestinal failure
- cirrhosis from hepatocellular disease: AI hepatitis, hepatitis, alpha-1-antitrypsin, NAFLD
PREHEPATIC
- portal vein occlusion: thrombosis, tumour, drugs, Tunrers, HIV, CF, idiopathic
POSTHEPATIC
- hepatic vein obstruction: Budd-Chiari, IVC obstruction, CHF, VOD
Appendicecostomy
(Malone/MACE)
use: bowel washouts for megacolon/severe constipation
mechanism: catheter inserted to washout
Appendicovesicostomy
(Mitrafonoff)
use: stoma for access to bladder
- ectopic bladder, spina bifida
- 4 hourly catheters
risks: increased bladder cancer, stenosis
Gastrostomy
indications:
- poor intake
- risk of aspiration: +/- fundoplication
FTT
Reduced intake
- inadequate calories: neglect, food refusal
Malabsorption
- pancreatic insufficiency
- enteropathy: post-infective, allergic, coeliac
Increased losses
- diarrhoea, vomiting
- GORD
- increased energy expenditure: chronic illness, anaemia
Investigations: FBC, film, iron, EUCs, TFT, coeliac screen
Describing a liver/spleen
Causes of obesity
Complications obesity
complications:
- HTN
- non alcoholic steatohepatitis
- hypercholesterolaemia
- insulin resistance
- type 2 diabetes
- OSA
- PCOS
investigations:
- TFTs
- Fasting glucose
- Lipid profile
- insulin level
management:
- prevention: public health campaigns, reduced advertising of junk food
- weight reduction programmes: involve whole family
- decrease sedentary behaviour
GI issues in CF
pancreatic
- insufficiency 85%: FTT, steatorrhoea
- pancreatitis
- abnormal glucose tolerance
- IDDM 7%
intestinal
- meconium ileus
- atresias
- rectal prolapse
- DIOS
hepatobiliary
- cholestasis in infancy: obstructive jaundice
- fatty liver
- focal biliary fibrosis
- multilobar cirrhosis
- abnormalities gallbladder
- cholelithiasis
- CBD obstruction
Crohn’s
extra-intestinal symptoms:
eyes: uveitis
joints: peripheral arthritis
skin: erythema nodosum, pyoderma gangrenosum, erythema multiforme
growth failure
pubertal delay
treatment:
- enteral nutrition
- anti-inflammatories: ASAs
- corticosteroids
- immunosuppresants
- biological agents
- surgery
Malabsorptive disorders
differential
- coeliac disease
- Cow’s milk protein intolerance or allergy
- CF
- immunodeficiency
others: infection, giardiasis, autoimmune disease
Coeliac disease
clinical: FTT, pallor, irritability, diarrhoea, dermatitis herpetiformis
investigations:
- tTG and IgA (10% IgA deficiency)
- biopsy
- HLA B8: diabetics screened at diagnosis and 3 yearly
Causes of constipation
causes:
- functional
- Hirschsprung’s
- thyroid disease
- meconium ileus
- spina bifida
Umbilical hernia associations
associations
- hypothyroidism
- storage disorders eg. MPS
- BWS
- trisomy 18
- trisomy 13
causes of ascites
causes:
- cirrhosis
- congestive cardiac failure
- nephrotic syndrome
- protein losing enteropathy
Hepatomegaly
most likely shorts:
- glycogen and other storage disorders
- right sided heart failure
Differential
Structural: EHBA, choledochal cyst, intrahepatic biliary hypoplasia, polycystic disease, congenital hepatic fibrosis
Storage/genetic: glycogen storage disorders, Gaucher disease, haemochromatosis, non alcoholic fatty liver disease
- WATCH: Wilson’s, A1AT, tyrosinaemia, CF, HFI
Haematological: thalassaemia, sickle cell disease, ALL, CML
Heart: CHF, constrictive pericarditis, obstructed IVC
Infection/inflammatory: Hep A/B, EBV, CAH, chronic persistent hepatitis, AI hepatitis
Infiltrative: sarcoidosis, histiocytosis X
Rheum/Reticuloendothelial: SLE, SJIA, NHL, Hodgkin’s disease
Tumour/Trauma: hepatic hamartoma, hepatoblastoma, HCC
Glycogen storage disease 1
von Gierke’s
genetics: AR glucose-6-phosphatase activity
presentation: hypoglycaemia and hepatomegaly <6 months
clinical:
- short
- doll like facies
- large liver
- platelet dysfunction
management: overnight carbohydrate feeds
complications: renal calculi/haematoma, poor neurodevelopment
Note: Type II has hepatomegaly, myopathy, DD
Gauchers
genetic: AR deficiency glycosylceramide beta-glucosidease
clinical: accumulation in reticuloendothelial cells
- portal HTN
- cirrhosis
Splenomegaly
Cardiac: SBE
Connective tissue disease: SJIA, SLE
Haematological: haemolytic anaemias (spherocytosis, G6PD deficiency, thalassaemia)
Infection
Malignancy: leukaemia, lymphoma
Portal hypertension
Storage disorders: Gauchers, Niemann-Pick
Commonest causes portal hypertension
causes:
- cirrhosis
- portal vein obstruction
- congenital hepatic fibrosis
- hepatic vein outflow obstruction
differentials:
prehepatic
- portal vein thrombosis
intrahepatic
- presinusoidal: neoplasia, schistosomiasis, hepatic cyst
- sinusoidal: congenital hepatic fibrosis, cirrhosis, biliary atresia
- postsinusoidal: VOD
posthepatic
- Budd-Chiari syndrome, RVF, constrictive pericarditis
clinical:
- splenomegaly
- bleeding
Cirrhosis
causes: “big tan”
biliary tract disorders
- BA, choledochal cyst, congenital hepatic fibrosis
infections
- hepatitis B/C, CMV
genetic/metabolic
- A1AT, Wilson’s, glycogen storage disease
toxins/drugs
- alcohol
autoimmune
nutrition
- TPN
Complications cirrhosis
- portal HTN
- bleeding diatheses
- increased susceptibility to infections
- ascites
- pulmonary HTN
- hepatoma
- malnutrition
- gallstones
- renal failure
- hepatic encephalopathy
- endocrine changes
- impaired hepatic metabolism of drugs/hormones
- impaired neurodevelopment
Barium studies
barium swallow: oesophagus for reflux or abnormal motility
modified barium swallow: observe swallowing (oral, pharyngeal, upper oesophagus)
- to identify difficult/impaired swallow
barium meal: stomach/duodenum
