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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


  • 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


  • 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; (young adults)


Firm cystic lumps associated with joints or tendon sheaths.


  • 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)


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


  • 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.


  • 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 ...

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