Gastroenterology Flashcards
Define acute liver failure
Failure of liver to perform its functions <8weeks duration +/- encephalopathy with no underlying chronic liver disease
Define chronic liver failure
Failure of the liver to perform its functions for >3months caused by continuous inflammatory disease which progresses to fibrosis, modular formation and portal hypertension
How does acute liver failure present?
Malaise
Stupor
Encephalopathy
Bleeding tendency
Jaundice
Vomiting
Loss of appetite
Fetor hepaticus
Ascites
Large or small liver
How does a chronic liver failure patient present?
Jaundice
Dark urine
Pale stool
Haematemesis
Melena stool
Loss of weight
Loss of appetite
Steatorrhoea
Abnormal mental state
Clubbing
Palmar erythema
Bruising
Rickets
Spider a evil
Scratch marks
Corneal clouding
Haemorrhoids
Abdominal veins
Causes of acute liver failure
Toxins/drugs
Metabolic
Infections
Vascular
Causes of chronic liver failure
Chronic hepatitis
Toxins/drugs
Metabolic
Cholestatic causes
What are the danger signs of liver failure?
> confusion/coma = hyper ammonia is, hypoglycaemia, cerebral oedema
hepatic flap/asterixis + positive babinski + increased reflexes = hepatic encephalopathy
bleeding and bruising
fever/sepsis
renal failure
ascites
TSB rising while ALt and AST falling
How do you diagnose conj hyperbilirubinaemia on lab results?
Conj bili > 20% of total bili
How is constipation described?
Decreased frequency of bowel movement
Increased size of stool
Firm consistency
Pain/discomfort with defecation
Delayed intestinal transit time
What are the causes of constipation?
> neurogenic = hirschprungs, CP
anal lesions = fissure, atresia, stenosis
endocrine/metabolic = hypothyroidism, renal acidosis
neuromuscular = muscular dystrophy
drugs = antacids, morphine
abnormal abdominal musculature = prune belly, downs
What are the red flags of a child presenting with constipation?
> onset <12months of life
delayed passage meconium
not stool withholding
no soiling
intermittent diarrhoea and explosive stools
failure to thrive
empty rectal ampulla
tight anal sphincter
gushing of stool on rectal exam
abnormal neuro exam
pigmentary abnormalities
presence of extra intestinal symptoms
bladder disease
no response to conventional treatment
heme positive stools
How do you medically disimpact stool?
Oral
>mineral oil 15-30ml/year of age
>polyethylene glycol 1.5g/kg/day
Rectal
>phosphate enema
>glycerine suppository
How is constipation treated in children?
Parent education
Diet and lifestyle modifications
Disimpaction
Maintenance (laxatives)
Achieve normal frequency
Stop medication
