persistent tenderness w guarding in the R iliac fossa (Mcburney's pt)
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
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
obstructive jaundice:
B. 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
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
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
