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year 3 consolidation weeks > CCC Renal and Liver > Flashcards

CCC Renal and Liver Flashcards

1
Q

What is the A to E for hands in liver disease?

A 
Asterixis
Bruising
Clubbing
Dupuytrens contracture 
Erythema
Leuconychia
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2
Q

What might indicate renal disease in a patient’s arm?

A

IV fistulae

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3
Q

What might be a sign on the chest of liver disease?

A

Gynaecomastia
Hair loss
Excoration marks
Spider nevae

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4
Q

What’s caput medusae?

A

Distended superficial abdominal veins, direction of flow below umbilicus is towards the legs when pressed

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5
Q

Causes of hepatomegaly?

A

Cancer
Cirrhosis (early alcoholic)
Cardiac - congestive cardiac failure, constrictive pericarditis

Infection (hepatitis)
Inflammation (sarcoidosis)
Malignancy

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6
Q

Causes of liver disease?

A 
Alcohol
Autoimmune
Drugs
Viral 
Biliary disease
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7
Q

Causes of splenomegaly?

A

portal Hypertension
Haematological
Infection (EBV, endocarditis, TB)
Inflammation

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8
Q

What might a high heart rate and low blood pressure suggest?

A

A haemodynamically unstable patient, e.g. ruptured aortic aneurysm.

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9
Q

What is the difference between colicky and constant pain?

A

Constant - inflammation

Colicky - obstruction

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10
Q

Causes of epigastric pain?

A

Think about what’s there! Pancreas, stomach

Pancreatitis (risk of gallstones)
GORD (better with antacids)
Peptic ulcer (NSAID USE)
Gastritis (retrosternal, ETOH)

AAA (pain coming from below epi back pain)
MI (just above)
Gall bladder/liver (from the right)

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11
Q

Difference between acute and chronic pancreatitis?

A

Acute - pain and high amylase

Chronic - pain, weight loss, normal amylase, faecal elastase and loss of exo and endocrine function

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12
Q

Causes of RUQ pain?

A

Gall bladder:
Cholecystitis
Cholangitis
Gallstones

Liver:
Hepatitis

Above - basal pneumonia
Below - appendicitis
Left - peptic ulcer, pancreatitis
Right - kidney

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13
Q

Causes of RIF and LIF pain?

A 
GI: 
Appendicitis
Mesenteric adenitis
Colitis (IBD)
Malignancy
Diverticulitis
Hernia
Gynae:
Ovarian cyst rupture or bleed
Ovarian torsion
Ectopic pregnancy
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14
Q

Causes of suprapubic pain?

A

Cystitis

Urinary retention

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15
Q

Causes of diffuse abdominal pain?

A

Obstruction
Infection - peritonitis, gastroenteritis
Inflammation - IBD
Ischaemia - mesenteric ischaemia

Medical - DKA, addison’s (excess pressure areas are darker e.g. bra), hypercalcaemia, porphyria, lead poisoning

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16
Q

Why would amylase be high after abdominal surgery?

A

Amylase is high in acute abdomen!

Bicarb is low and lactate high in ischaemia

17
Q

What ascites neutrophil count is consistent with SBP (spontaneous bacterial peritonitis)?

A

Higher than 250!

18
Q

Causes of abdominal distention?

A

Fluid - ascites - shifting dullness and features of liver disease
Flatus - obstruction - N&V, not opened bowel, high-pitched tinkling, previous surgery, tender irreducible femoral hernia in groin
Fat
Faeces
Fetus

19
Q

Classifications of ascites?

A

Transudate - cirrhosis, cardiac failure, nephrotic syndrome

Exudate - malignancy, budd chiari, pylonephritis

20
Q

Why would a stool be pale and urine be dark?

A

In hepatitis, conjugated bilirubin can leak into urine making it dark. Obstruction can cause the same, and also reduces movement into intestines, so stool is pale and lacks stercobilinogen.

Pre-hepatic - haemolysis, defective conjugation
Hepatic - hepatitis
Post-hepatic - CBD obstruction

21
Q

What does obstruction of the liver, obstructive jaundice, cause on LFTs?

A

Increased ALP and gamma gt

CA19-9 is a pancreatic cancer marker, if high could be cause of obstruction.

22
Q

Bloody diarrhoea causes?

A

Infection - campylobacter, e.coli, salmonella, shigella
Inflammation - inflammatory colitis in young and with extra manifestations e.g. ulcers, uveitis, arthritis
Ischaemic in elderly
Malignancy and diverticulitis

23
Q

IMAGE

What is thumb print sign?

A

Thickening of bowel wall, so clear walls on x-ray

24
Q

IMAGE

What is lead pipe sign?

A

Seen in ulcerative colitis

25
Q

IMAGE Dilated bowel

A

/

26
Q

What is spurisis/overflow diarrhoea?

A

Faecal loading that causes leaking

27
Q

Management of GI bleed?

A 
ABC
IV access
Fluids
G&S, x-match blood
OGD

Variceal bleed from liver disease prophylactically treat

  • ABx
  • Terlipressin
28
Q

How do we manage acute abdomen?

A

FBC, U&Es, LFTs, CRP, clotting, G&S, x-match
Erect CXR
CT
Gallstones suspected - USS after fast

NMB
Fluids
Analgesic
Anti-emetics
ABx
Monitor vitals and UO
29
Q

Dysphagia or PR bleed with weight loss

investigations?

A

OGD and biopsy for dysphagia

Colonoscopy for PR

30
Q

Treatment for patient with ascites?

A

Diuretics
Dietary sodium restriction
Fluid restriction in patients with low sodium
Monitor weight daily
Therapeutic paracentesis (draining) (with IV human albumin)

31
Q

How to calculate cause of ascites?

A

Serum albumin - ascites albumin =

> 11 - cirrhosis, cardiac failure (low ascites albumin, low protein)
<11 - TB, cancer, nephrotic syndrome (high protein from inflammation)

32
Q

Treatment of hepatic encephalopathy?

A

Lactulose to remove ammonia
Phosphate enemas

Avoid sedation
Treat infection
Exclude GI bleed

33
Q

Post-operative complications?

A

Wound infection - erythematosus, discharge
Anastomotic leak - diffuse abdo tenderness, guarding, rigidity
Pelvic abscess

34
Q

MORE WORK

Perianal disease

A

Abs

35
Q

Presentation of IBS

A

Recurrent abdo pain, bloating
Improves with defecation
Change in bowel habits
Excluse coeliac

Treatment with diet and lifestyle, laxatives, anti diarrhoea or antispasmodic for pain.

36
Q

Acute kidney injury (high urea and creatinine) causes.

A

Pre-renal - sepsis, hypovolaemia

Renal - glomerulonephritis

Post-renal - outflow obstruction e.g. cancer (prostate cancer), calculi, BPH

year 3 consolidation weeks (8 decks)

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