Handbook Section 1 Flashcards
DxT Acute diarrhoea + colicky abdominal pain ± vomiting
gastroenteritis
DxT (Young adult) diarrhoea ± blood and mucus + abdominal cramps
inflammatory bowel disease (UC/Crohn)
DxT Pale bulky offensive stools, difficult to flush, weight loss
malabsorption
DxT (Young adult) diarrhoea ± blood and mucus + abdominal cramps
DxT As above + constitutional symptoms ± eyes/joints
Crohn disease
DxT Fatigue + weight loss + iron deficiency
coeliac disease
DxT Failure to thrive (child) + recurrent chest infections
cystic fibrosis
DxT Altered bowel habit: diarrhoea ± constipation ± rectal bleeding ± abdominal discomfort
colorectal carcinoma
DxT Diarrhoea (fluid/incontinent) + constipation +++ abdominal discomfort + anorexia/nausea
faecal impaction
DxT Profuse watery diarrhoea + abdominal cramps and increasing distension (on antibiotics)
pseudomembranous colitis (Girotra’s triad)
DxT Variable diarrhoea/constipation + abdominal discomfort + mucus PR + flatulence ++
irritable bowel syndrome
Basic Diarrhoea management
In Australia most infective cases are viral. The basic principle therefore is to achieve and maintain adequate hydration until the illness resolves. In adults and children oral rehydration is indicated unless there is evidence of impending circulatory ‘shock’ demanding intravenous
therapy. Oral rehydration solution containing sodium, potassium and glucose should be considered for patients with mild to moderate dehydration. Adults should drink 2 to 3 L of the solution in 24 hours. Normal food intake may start after rehydration.
Cause pseudomembranous colitis
This potentially fatal colitis can be caused by the use of any antibiotic, especially clindamycin, lincomycin, ampicillin and the cephalosporins (an exception is vancomycin). It is usually due to an overgrowth of C. difficile, which produces a toxin that causes specific inflammatory lesions, sometimes with a pseudomembrane.
Pseudomembranous colitis is diagnosed by
Diagnosed by characteristic lesions on sigmoidoscopy and a tissue culture assay and/or PCR for C. difficile toxin.
Pseudomembranous colitis, treated by
Cease antibiotic
Need hygiene measures to prevent spread
Mild to moderate: metronidazole 400 mg (o) tds for 10 days
Severe: vancomycin 125 mg (o) qid for 10 days
(in consultation with specialist). Beware of toxic megacolon.
Molluscum Contangiosum, diagnosed by
Molluscum is usually diagnosed by its distinct pink pearly appearance and central punctum. It is very common in
children. The rash lasts weeks to months, or occasionally a couple of years.
Molluscum rarely leaves tiny pit-like scars.
Molluscum Contangiosum, spread by
direct contact, sharing towels and bath toys, or through water (e.g. sharing baths or swimming).
Molluscum Contangiosum, treated by
The most common approach in children is to leave the rash alone and wait for it to clear. Treatments designed to irritate the lesion can make the rash clear more quickly (see CHAPTER 124 ) but can be distressing to the child and so are not normally done.
Molluscum Contangiosum, caused by
Pox virus
Acute inflammatory polyradiculoneuropathy (Guillain–Barré syndrome), definition
Guillain–Barré syndrome, which is a rapidly progressive and treatable cause of PN or ascending radiculopathy, is potentially fatal. Early diagnosis of this serious disease by the family doctor is crucial as respiratory paralysis may lead to death. The underlying pathology is segmental demyelination of the peripheral nerves and nerve roots.
Acute inflammatory polyradiculoneuropathy (Guillain–Barré syndrome), clinical feature
Weakness in the limbs (usually symmetrical)
Paraesthesia or pain in the limbs (less common)
Both proximal and distal muscles affected, usually starts peripherally
and moves proximally
Reflexes depressed or absent
Within 3–4 weeks the motor neuropathy, which is the main feature, progresses to a maximum disability, possibly with complete quadriparesis and respiratory paralysis.
Acute inflammatory polyradiculoneuropathy (Guillain–Barré syndrome), investigation
CSF protein is elevated; cells are usually normal.
Motor nerve conduction studies are abnormal.
Acute inflammatory polyradiculoneuropathy (Guillain–Barré syndrome), management
Admit to hospital.
Respiratory function (vital capacity) should be measured regularly (2–4 hours at first).
Tracheostomy and artificial ventilation may be necessary.
Physiotherapy to prevent foot and wrist drop and other general care
Treatment is with plasma exchange or IV immunoglobulin (0.4g/kg/day for 5 days), which may need to be continued monthly.
Inguinal hernias, presentation
These usually present in the first 3 to 4 months with an incidence of 1 in 50 males and 1 in 500 females
Inguinal and femoral hernias should be referred urgently as early surgery is advisable to avoid the high risk of bowel incarceration or strangulation and ovarian entrapment and ischaemia in females.
Inguinal hernias, when to refer
ASAP, infants and irreducible hernias
Reducible hernias: the ‘6–2’ rule
Birth–6 weeks: surgery within 2 days
6 weeks–6 months: surgery within 2 weeks
Over 6 months: surgery within 2 months