Abdominal exam and diarrhea

Question 1

State 5 causes of abdominal distension

Answer 1

Fat, faeces, gas,fluid
Hypotonic abdominal muscles resulting in protuberant abdomen
Visceromegaly- liver spleen
Exaggerated lordosis

Question 2

State 3 causes of splenomegaly under increased activity

Answer 2

Increased degradation of cells
Increased immune response
Compensatory extramedullary hematopoiesis by spleen

Question 3

State 3 purposes of an abdominal exam

Answer 3

To seek abdominal masses and fluid
To detect enlargement of abdominal organs
To seek the presence of normal abdominal structures

Question 4

State 4 characteristics of the liver

Answer 4

Dullness to percussion
Movement with respirations
Unable to get above it because it grows upwards
A palpable edge in the right hypochondrium

Question 5

State 3 kidney characteristics

Answer 5

Able to go above it
Moves on respiration
Has a smooth outline

Question 6

State 4 spleen characteristics

Answer 6

Moves with respirations when enlarged
Able to go above it
Dull to percussion
Has a notch

Question 7

State 4 unilateral kidney diseases

Answer 7

Congenital mesonephroma - Wilms
Renal vein thrombosis
Multicystic dysplasia
Hydronephrosis

Question 8

State 3 causes of bilateral kidney diseases

Answer 8

Polycystic kidney disease
Congenital nephrotic syndrome
Bilateral obstructive uropathy secondary to posterior urethral valves

Question 9

Causes of ascites in newborn babies x5

Answer 9

Biliary rupture of common bile duct
Chylous rupture of lymphatic duct
Urinary rupture of bladder
An exudate in peritonitis
A transudate in hydrops or heart failure

Question 10

State 4 things you inspect on rectal exam

Answer 10

Protruding polyps
Threadworms
Anal fissures
Skin tags

Question 11

State the causes of different bowel sounds x3

Answer 11

Absent- paralytic ileus
Hyperactive- normal, GE, Upper GI bleeding
Intense and tingling- mechanical obstruction

Question 12

Define secretory diarrhea

Answer 12

Water and electrolytes excreted into the intestines after toxin stimulation > overwhelmed absorptive capacity of the colon

Question 13

Define osmotic diarrhea

Answer 13

Unabsorbed nutrient and solutes create an osmotic gradient which draws water into the lumen

Question 14

State the 3 main forms of diarrhea

Answer 14

Acute watery - hours to days
Dysentery - nutrient loss
Persistent >14 days

Question 15

State why young children are more vulnerable to dehydration x4

Answer 15

Malnutrition
Higher metabolic rates
Kidneys less able to conserve water
Water constitutes a greater proportion of the body weight

Question 16

Diarrhea prevention in children x2

Answer 16

Prevent exposure to pathogens through wash
Make the child less susceptible by immunizations and adequate nutrition

Question 17

3 ways to obtain safe water

Answer 17

Treating water at the source
Treating household water
Storing water safely

Question 18

Ways of making the child less susceptible to diarrhea x3

Answer 18

Immunizations
Adequate nutrition
Micronutrient supplementation

Question 19

3 ways in which repeated diarrhea bouts worsen nutritional status

Answer 19

Decreased food intake
Reduced nutrient absorption
Increased nutritional requirements

Question 20

Effect of zinc on diarrhea x3

Answer 20

Reduction in recurrence
Reduction in duration of acute diarrhea
Reduction in treatment failure and death in persistent diarrhea

Question 21

Clinical signs of some dehydration x5

Answer 21

Sunken eyes
Restlessness
Irritable
Drinks eagerly
Skin pinch which goes back slowly

Question 22

Clinical signs of severe dehydration x5

Answer 22

Lethargic
Unconscious
Sunken eyes
Unable to drink
Skin pinch goes back very slowly

Question 23

State 4 things to assess in physical examination of a patient with diarrhea

Answer 23

Assess for
1. Danger signs- shock
2. Severe malnutrition
3. Hydration
4. Abdominal surgical problems

Question 24

State the most common cause of dysentery and the associated symptoms x4

Answer 24

Shigella
Abdominal pains, fever, lethargy and dehydration

Question 25

State 4 species of dysentery

Answer 25

S. dysenteriae S flexneri S boydii S.sonnei

Question 26

State the classical triad of Hemolytic uremic syndrome HUS

Answer 26

Hemolytic anemia Acute kidney injury Thrombocytopenia- low platelet count

Question 27

Why does ORS work

Answer 27

It delivers sodium and glucose to the small intestines which are co transported into cells and water follows by osmosis due to gradient created

Question 28

Describe the effect of too much glucose and sodium in ORS

Answer 28

Glucose- increased osmotic load which can worsen diarrhea Sodium- no organic solute for transport resulting in hypernatremia or worsening of diarrhea

Question 29

State 5 predisposing factors of persistent diarrhea

Answer 29

Poverty Poor hygiene Early weaning Prolonged fasting Micronutrient deficiency

Question 30

Describe mechanisms that cause development of persistent diarrhea x4

Answer 30

1.Use of antibiotics wipes away normal flora 2.Lactose intolerance - acute diarrhea cause villus damage where lactase enzyme is present 3.Some pathogens dampen host immune response and delay clearance 4.Host factors- immunosuppression, micronutrient deficiency

Question 31

Causes of diarrhea in HIV x4

Answer 31

ARTs GI infections GI manifestations of TB HIV related malabsorption

Question 32

3 key features of diarrhea treatment

Answer 32

Zinc supplementation Continued feeding Oral rehydration therapy

Question 33

Non infectious etiologies of persistent diarrhea x4

Answer 33

Malabsorption Celiac disease Irritable bowel syndrome Inflammatory bowel disease

Question 34

State 4 causes of malabsorption

Answer 34

Mucosal malabsorption Bile acid insufficiency Pancreatic exocrine insufficiency Lactose intolerance

Question 35

Define ulcerative colitis and crohns disease

Answer 35

Ulcerative- inflammation of the mucosal layer of the colon Crohns- transmural inflammation of any part of GI tract

Question 36

GI manifestations of IBD x5

Answer 36

Chronic relapsing and remitting diarrhea Abdominal pain and tenesmus Strictures fistulas and perianal skin tags

Question 37

Define IBS

Answer 37

Chronic recurrent abdominal pain and altered bowel habits without underlying organic disease

Question 38

Celiac disease

Answer 38

Gluten sensitive disease which results in immune mediated mucosal inflammation of the proximal small intestines > malabsorption

Question 39

Clinical manifestations of celiac diseases x5

Answer 39

Rash, weight loss Iron deficiency anemia Neurobehavioral symptoms Chronic diarrhea, abdominal pain

Question 40

4 groups that get empiric antibiotics in diarrhea

Answer 40

Infants <3m Preterm babies up to 52 weeks Suspected shigella infection Patient with concern for sepsis

Question 41

When do you suspect cholera x3

Answer 41

Children >2years Profuse watery diarrhea Signs of severe dehydration and shock

Question 42

Management of cholera and how it works x2

Answer 42

Azithromycin: 20mg/kg single dose Erythromycin: 2.5mg/kg for three days It shortens disease and reduce infectivity