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2010-09-30 20:13:29
gastro paeds

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  1. Signs and Symptoms of Appendicitis
    • symptoms:
    • anorexia
    • vomiting
    • abdo pain
    • signs:
    • flushed face w oral fetor
    • low-grade fever 37.2-38
    • abdo pain aggravated by movement
    • persistent tenderness w guarding in the R iliac fossa (Mcburney's pt)
  2. Diagnosis of appendicitis:
    • Pt Hx and Exn w elevated neutrophils
    • Atypical histories - imaging w US and/or CT
    • pregnancy test is vital in all women of child bearing age
  3. Necrotising enterocolitis:
    a. Typically seen in premature infants
    b. Initial symptoms include feeding intolerance, increased gastric residuals, abdominal distension and bloody stools
    c. Symptoms may progress rapidly to abdo discoloration w intestinal perforation, peritonitis and systemic hypotension
    requiring intensive medical support
    d.The pathognomic finding on plain films is pneumatosis intestinalis
    e. immediate emergency surgery to resect the dead bowel is generally required
    • Rx: primarily supportive care inc bowel rest by stopping enteral feeds, gastric decompression with intermittent suction, fluid repletion to correct electrolyte abnormalities and third space losses, support for bp, parenteral nutrition, and prompt Abx therapy.
    • if not managed medically, or when the bowel perforates, immediate emergency surgery to resect the dead bowel is generally required, although abdominal drains may be placed in very unstable infants as a temporizing measure
  4. obstructive jaundice:
    a. Post-hepatic jaundice
    b. interruption to the drainage of bile in the biliary system
    c. most common causes-gallstones in the common bile duct, and pancreatic cancer in the head of the pancreas.
    d. presence of pale stools and dark urine suggests an obstructive cause as normal feces get their color from bile pigments
    e. "liver flukes" can live in the common bile duct, causing obstructive jaundice
    f. other causes: strictures of the common bile duct, biliary atresia, ductal carcinoma, pancreatitis and pancreatic pseudocysts
    g. primary biliary cirrhosis, Gilbert's syndrome
    • g. primary biliary cirrhosis (autoimmune disease of liver - destruction of small bile canniculi)
    • Gilbert's syndrome (redu activity of the enzyme glucuronyltransferase, (N conjugates bilirubin) and some other lipophilic molecules
    • these are both causes of hepatic jaundice
  5. Intestinal parasites:
    a. means of exposure: ingestion of undercooked meat, drinking infected water, and skin absorption
    b. major groups of parasites include protozoans (organisms having only one cell) and parasitic worms (helminths)
    c. Common signs and symptoms include: abdo pain, diarrhea, n&v, flatulence or bloating, dysentery, rash or itching around the rectum or vulva, lethargy, anorexia, passing a worm in your stool
    d. is treated by hydration only
    e. Some parasites can cause anaemia, and some travel from the lungs to the intestine, or vv and other parts of the body
    • Iodoquinol inhibits several enzymes of protozoans- orally for asymptomatic amebiasis either by itself or w metronidazole for intestinal and hepatic amebiasis
    • Quinacrine is the drug of choice for giardiasis, (caused by a flagellated amoeba)
    • Trypanosomes are flagellated protozoans: chagas disease: rx w nifurtimox
    • Malaria: more serious protozoal infections: Chloroquine phosphate, orally, drug of choice for prophylaxis and rx
  6. Irritable bowel syndrome:
    a. is a diagnosis of exclusion.
    b. characterized by chronic abdo pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause
    c. treatments attempt to relieve symptoms, including dietary adjustments (no evid), medication (laxatives and antidiarrheals depending on if it is IBS-C or IBS-D or IBS-A) (tca) and psychological interventions (cbt and hypnosis)
    d. IBS-D = diarrhoea, IBS-C = constipation, IBS-A = acute
    e. Ppl with IBS are more likle to have: GORD, Sxs relating to the genitourinary system, the sleepy disease, fibromyalgia, headache, backache and psychiatric symptoms such as depression and anxiety
    IBS-A = alternating (pain predominant)