GI and Abdo

Question 1

Core Gastro exam?

Answer 1

IC HIUG DEP V
* Iatrogenic - scars, NGT, PEG, TPN, long line, Tenckhoff (dialysis), IDC
* Jaundice
* Growth
* Dysmorphism
* Vital - BP (renal artery stenosis), HR

Hands
Nails
* Clubbing
* Leukonychia (low alb)
* Koilonychia (spoon shaped, Fe deficiency)
Palms
* Pallor
* Erythema

* Hepatic flap 
* Xanthomata (yellow deposits - cholesterol)

Arms
* Subcutaneous fat stores
* Spider naevi
* Bruising
* Scratch marks

Face
* Eyes - conjunctival pallor, scleral icterus
* KF rings (slit lamp)
* Facial plethora

Mouth
* Mouth ulcers
* Glossitis, macroglossia
* Gum hypertrophy (cyclosporin, phenytoin)
* Freckling

Abdomen
Inspect
* Scars
* Stomas -
* Distension
* Masses
* Caput medusae

Palpate
* Each quadrant - Light –> deep
* Liver
* Spleen
* Ballot kidneys

Percuss
* Liver, spleen edges
* Shifting dullness - ascites

Auscultate
* Bruit
* Bowel sounds

Legs
* Peripheral edema
* Erythema nodosum

Extra
* Chest - heart, pleural effusions
* Anus and genitalia

Question 2

Nutritional assessment - core exam?

Answer 2

IC HIUG VIDEP V
* Iatrogenic -NGT, PEG, TPN, previous surgeries

Growth
* Weight, height, HC
* Midparental height
* Ask for birth weights, previous weights

Hands
* Nails - koilonychia (low alb), leukonychia (low Fe), clubbing
* Palmar creases - anaemia
* Skin:
* Xerosis (dry, scaly) - essential fatty acids
* Bruising, petechiae - Vit K, Vit C
* Hyperkeratosis - Vit A

Arms
* Subcutaneous fat stores
* Muscle bulk
* Proximal muscle

Head
* Alopecia (hair loss)
* Hair pull test
* Depigmentation
* Fontanelle
* Eyes: conjunctival pallor (Fe, B12, folate), periorbital edema
* Mouth:
* Angular stomatitis (cracking lips) - riboflavin Vit B2, Fe
* Cheilosis (chelitis) -
* Glossitis (tongue) - riboflavin, pyridoxine (Vit B6), B12
* Spongy, bleeding gums - Vit C
* Dentition (Vit D)

Abdo
* Inspect
* HSM
* Ascites
* Scrotal edema

Trunk (Chest)
* Rachitic rosary (bead looking on ribs, Ricketts)
* Bony prominences
* Resp - creps
* Sacral edema
* Port - TPN

Cardio
* Flow murmur - anaemia

Legs
* Muscle bulk (quads)
* Periph edema
* Nail changes
* Peripheral sensation - proprioception and vibration - B12, B6, B1, B3, Vit E

Standing
* Proximal weakness
* Gluteal muscle bulk
* Tibial/femoral bowing

Ask for
* Pubertal status
* Anogenital exam
* Urinanalysis
* Stool - malabsorption

Summary
* Growth parameters
* Macronutrient problem (fat or protein)
* Micronutrient problem - minerals, fat soluble vitamins, water soluble vitamins

Question 3

Splenomegaly DDx?

Answer 3

PHIMM
* Portal hypertension
* Haematological - hereditary spherocytosis, G6PD, thalassemia
* Infective - EBV, SBE
* Inflammatory - SLE, RA
* Malignant - haematological
* Metabolic - lysosomal storage disease (Gaucher, MPS, Niemann Pick)

Question 4

Hepatomegaly DDx?

Answer 4

SHIIMM
* Structural - choledochal cyst, extra hepatic biliary atresia, progressive familial intrahepatic cholestasis
* Heart - RHF
* Haematological - thalassemia, sickle cell
* Infective - viral hepatitis, EBV, CMV
* Inflammatory - autoimmune hepatitis, IBD associated liver disease
* Malignancy
Metabolic - lysosomal storage disorders, MPS, protein, alpha 1 antitrypsin Wilson’s

Question 5

Hepatosplenomegaly DDx?

Answer 5

PHIIMMC
* Portal HTN secondary to liver disease
* Haematological - chronic haematological, thalassemia
* Infection - EBV, CMV, acute viral hepatitis
* Inflammatory - SLE, RA
* Malignant - haematological
* Metabolic
Congenital hepatic fibrosis

Question 6

Chronic Liver Disease DDx?

Answer 6

BAMII
Biliary
* Intrahepatic- congenital hepatic fibrosis, sclerosing cholangitis, syndromic - Alagille
* Extra-hepatic - biliary atresia, choledochal cyst, progressive familial intrahepatic cholestasis, cystic fibrosis

Autoimmune
* Autoimmune hepatitis

Metabolic
* CHO (glycogen storage disease, galactosemia), protein (tyrosinemia), lipid (Gaucher’s)

Infection
* Hepatitis

Iatrogenic
* TPN, drugs

Vascular
* Post Fontan, Budd Chiari

Question 7

Portal HTN signs?

Answer 7

• Splenomegaly
  
  • Ascites
  • Peripheral edema
    Collateral veins - haematemesis esophageal/gastric varices

Question 8

Decompensation liver disease signs?

Answer 8

• Jaundice, scratch marks
  
  • Ascites
  • Asterixis
  • Disorientation time/place/person
    Bruising

Question 8

Decompensation liver disease signs?

Answer 8

• Jaundice, scratch marks
  
  • Ascites
  • Asterixis
  • Disorientation time/place/person
    Bruising