G

GAMBLING

Problem or pathological gambling is persistent and recurrent maladaptive gambling behaviour despite its detrimental effect (disruption of personal, family or work life). It is undoubtedly a dependence disorder similar to alcohol and other drugs with a similar approach to management.

Prevalence: 2–3% of adult population

Dangers

• Suicide risk (high)

• Major depression (up to 75%)

• Stress-related problems

• Domestic violence

Key warning signs

• Gambling >$200 wk

• Chasing losses

Other telltale signs

• Spending many hours gambling

• Placing larger, more frequent bets

• Lying about behaviour

• Being secretive

• Promising cutting back but not doing it

• Impulsive activity

• Mood swings

• Gambling at expense of other pleasant social activities

• Growing debts

• Excessive drinking

Management

• Ask (as part of social history)

• Consider South Oaks Gambling screen

• Firm confrontation if suspected

• Consider using the Prochaska and Di Clemente model of change

• Give education and basic counselling

• Look at family ?domestic violence

• Advise family not to provide ‘rescue money’

• Refer for specialist counselling if necessary; this includes CBT

• Drug treatment inadvisable

• Helpful agencies: Lifeline 13 11 14; Gambler’s help 1300 131973; eheadspace.org.au (young adults)

GANGLION

Firm cystic lumps associated with joints or tendon sheaths.

Management

• Can be left to wait and see

• Do not ‘bang with a Bible’

• Needle aspiration and steroid injection:

  • – insert 21 g needle with 5 mL syringe

  • – aspirate some of contents and change syringes

  • – inject 0.5 mL corticosteroid (depot)

  • – can be repeated with 0.25 mL in a few wks

• Surgical excision (can be difficult)

GASTROENTERITIS

In children

An illness of acute onset, of less than 10 days duration associated with fever, diarrhoea and/or vomiting, where there is no other evident cause for the symptoms.

Prevention: Rotavirus vaccine <6 mths

Causes

• Viral (80%): mainly rotavirus, norovirus and adenovirus

• Bacterial: C. jejuni & Salmonella sp. (two commonest), E. coli & Shigella sp.

• Protozoal: Giardia lamblia, Entamoeba histolytica, Cryptosporidium

• Food poisoning—staphylococcal toxin

Note: Dehydration from gastroenteritis is an important cause of death, particularly in obese infants (esp. if vomiting accompanies the diarrhoea).

Exclude acute appendicitis and intussusception in the very young.

Symptoms

• Anorexia, nausea, poor feeding, vomiting, fever, diarrhoea (fever and vomiting may be absent)

• Fluid stools (often watery) 10–20/d

• Crying due to pain, hunger, thirst or nausea

• Bleeding uncommon (usually bacterial)

• Anal soreness

Assessment of dehydration

The simplest way is by careful clinical assessment (e.g. urine output, vomiting, level of thirst, activity, pinched skin test). The most accurate ...