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Clinical Exam > Gastrointestinal exam > Flashcards

Gastrointestinal exam Flashcards

1
Q

Portal hypertension

causes

A

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
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2
Q

Appendicecostomy

(Malone/MACE)

A

use: bowel washouts for megacolon/severe constipation

mechanism: catheter inserted to washout

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3
Q

Appendicovesicostomy

(Mitrafonoff)

A

use: stoma for access to bladder

  • ectopic bladder, spina bifida
  • 4 hourly catheters

risks: increased bladder cancer, stenosis

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4
Q

Gastrostomy

A

indications:

  • poor intake
  • risk of aspiration: +/- fundoplication
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5
Q

FTT

A

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

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6
Q

Describing a liver/spleen

A
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7
Q

Causes of obesity

A
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8
Q

Complications obesity

A

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
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9
Q

GI issues in CF

A

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
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10
Q

Crohn’s

A

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
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11
Q

Malabsorptive disorders

differential

A
  • coeliac disease
  • Cow’s milk protein intolerance or allergy
  • CF
  • immunodeficiency

others: infection, giardiasis, autoimmune disease

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12
Q

Coeliac disease

A

clinical: FTT, pallor, irritability, diarrhoea, dermatitis herpetiformis

investigations:

  • tTG and IgA (10% IgA deficiency)
  • biopsy
  • HLA B8: diabetics screened at diagnosis and 3 yearly
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13
Q

Causes of constipation

A

causes:

  • functional
  • Hirschsprung’s
  • thyroid disease
  • meconium ileus
  • spina bifida
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14
Q

Umbilical hernia associations

A

associations

  • hypothyroidism
  • storage disorders eg. MPS
  • BWS
  • trisomy 18
  • trisomy 13
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15
Q

causes of ascites

A

causes:

  • cirrhosis
  • congestive cardiac failure
  • nephrotic syndrome
  • protein losing enteropathy
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16
Q

Hepatomegaly

A

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

17
Q

Glycogen storage disease 1

von Gierke’s

A

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

18
Q

Gauchers

A

genetic: AR deficiency glycosylceramide beta-glucosidease

clinical: accumulation in reticuloendothelial cells

  • portal HTN
  • cirrhosis
19
Q

Splenomegaly

A

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

20
Q

Commonest causes portal hypertension

A

causes:

  1. cirrhosis
  2. portal vein obstruction
  3. congenital hepatic fibrosis
  4. 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
21
Q

Cirrhosis

A

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
22
Q

Complications cirrhosis

A
  • 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
23
Q

Barium studies

A

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

Clinical Exam (16 decks)

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