Gastroenterology

Question 1

DDx hepatomegaly

Answer 1

SHIRT

Structural = EHBA, choledochal cyst
Storage/Metabolic: storage disorders (GSD), MPS, alpha1AT, Wilsons, CF
Heart = RHF
Haematological = thalassaemia, sickle cell, leukaemia/ lymphoma
Infective = EBV, CMV, hep A, B, C
Rheumatological = autoimmune, SLE, sJIA
Tumour = primary or secondary, hepatoblastoma, neuroblastoma

Question 2

DDx Hepatosplenomegaly

Answer 2

PHIIMMC

Portal hypertension
Haematological = thalassaemia
Infective = EBV, CMV, acute viral hepatitis
Inflammatory = SLE, sJIA
Malignancy = haematological
Metabolic = lysosomal storage disorder (Gaucher, MPS, Niemann Pick)
Congenital hepatic fibrosis

Question 3

DDx Splenomegaly

Answer 3

PHIIMM

Portal hypertension
Haematological = any chronic haemolytic disorder, hereditary spherocytosis, G6PD
Infective = EBV, SBE
Inflammatory = sJIA, SLE
Malignant = haematological malignany
Metabolic = lysosomal storage disorer (Gaucher, Nieman Pick, MPS)

Question 4

DDx Jaundice + Splenomegaly

Answer 4

Hepatocellular - mixed or conjugated
- CLD + PHT

Haematological - unconjugated
- Haemolytic disorder
-> Enzyme - G6PD
-> Membrane -> HS
-> Haemaglobinopathies -> sickle cell

Question 5

Short Gut Causes

Answer 5

Congenital
- Congenital short bowel
- Atresia
- Gastroschisis

Acquired
- NEC
- Volvulus +- malrotation
- Hirshprung
- Crohns
- Trauma