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finals - paces > Abdo > Flashcards

Abdo Flashcards

1
Q

Causes / differential of jaundice

A

Pre-hepatic
- haemolytic anaemia

Hepatic
- liver failure

Post hepatic
- gallstone obstruction

Can tell apart by type of bilirubin that is high - unconjugated if pre hepatic, both in hepatic, conjugated if post hepatic. Post hepatic also has additional sx of pale stool, dark urine.

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2
Q

Causes of nail clubbing

A

Inflammatory bowel disease
Coeliac disease
GI lymphoma
Malabsorption

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3
Q

Subcostal / Kocher’s scar

Causes?

A

Cholecystectomy
Partial liver resection

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4
Q

Mercedes Benz Scar

Causes?

A

Hepatectomy?

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5
Q

Paramedian scar

Causes?

A
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6
Q

Lanz scar

Causes?

A
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7
Q

Midline laparotomy

Causes?

A

Major surgery involving whole abdomen
Emergency surgery

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8
Q

Presenting abdo exam (normal)

A

medical paraphanelia at bedside
Appeared clinically euvolemic, calm/comfortable at rest
Peripheral stigmata of disease in hands, face, neck or chest.

Closer inspection of abdomen - drain sites, stoma, scar to suggest previous surgical intervention.

Abdomen soft, non tender, no organomegaly.
Bowel sounds

Conclusion: normal abdominal examination

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9
Q

Presenting abdo exam (abnormal)

A

Paraphanelia
Volume status, patient at rest
Peripheral stigmata
Abdomen- drains, stoma, scars.
Abdomen - tender, organomegaly …

The most pertinent positive findings were ….
In keeping with a possible diagnosis of….

My other differentials would be ….. and I would like to further assess this patient by doing ……

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10
Q

Painful hepatomegaly differential

A

Substance-related:
Alcohol associated hepatitis
Toxic hepatitis - medication OD

Inflammatory:
Primary sclerosing cholangitis
Autoimmune hepatitis

Infective:
Viral hepatitis
Infectious Mononucleosis
Liver abscess

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11
Q

Painless jaundice differential

A

Prehepatic
- haemolytic anaemia

Hepatobiliary
- Pancreatic cancer
- Cholangiocarcinoma
- drug induced liver injury

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12
Q

Liver Transplant

Indications?

A
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13
Q

Liver Transplant

Immuosupressant therapy regimens?

A
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14
Q

Causes of poor wound healing?

A
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15
Q

Causes of splenomegaly

A

Haem:
* Chronic lymphocytic leukaemia
* Chronic myelocytic leukaemia
* Myelofibrosis

ID:
* EBV
* Infective endocarditis
* Malaria

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16
Q

Medications used in renal transplant

A
17
Q

Stoma types

A

Ileostomy
- liquid output
- spouted
- more often in RIF
- end = single, loop = double lumen

Colostomy
- solid output
- flush to skin
- more often in LIF
- end = single, loop = double lumen

18
Q

Types of dialysis & how they work

A

Haemodialysis
- blood removed from body, passed over membrane with dialysis fluid flowing in opposite direction, returned to body
- usually 3x/week
- access via AV fistula or central venous catheter e.g. Tesio

Peritoneal dialysis
- peritoneum forms semi permeable membrane
- (Tenckhoff) catheter inserted into peritoneum, dialysis fluid infused
- can be done at home

19
Q

Checking for patency of AV fistula

A

Palpate - thrill = patent
Auscultate - bruit = patent

Signs of infection, thrombosis

20
Q

Indications for dialysis (acute)

A

Acidosis
Electrolytes - hyperK not responsive to meds
Intoxication - with dialysable drug
Oedema
Uraemia

21
Q

Indications for renal transplant

A

Should be considered for all patients with/progressing towards G5 CKD

22
Q

Risks of renal transplant

A

From transplant
- Surgical: bleeding, infection, damage to structures
- acute rejection
- chronic rejection

From treatment
- malignancy
- atypical infections

+ Recurrence of CKD

23
Q

Stages of CKD

A

1 > 90
2 60-89
3a 45-60
3b 30-44
4 15-29
5 <15

NOTE: stage 1/2 need evidence of renal pathology e.g. proteinuria, haematuria, pathology on biopsy

24
Q

Stages of AKI

A

1: 1.5-1.9x baseline creatinine OR <0.5ml/kg/h for 6-12h
2: 2-3x baseline creatinine OR <0.5mL/kg/h for >12h
3: >3x baseline creatinine OR <0.5ml/kg/h for >24h OR Anuria for >12h

25
Q

Issues with peritoneal dialysis

A

Catheter site infection
Bacterial peritonitis
Hernia
Loss of membrane function

26
Q

Issues with haemodialysis

A

Requires access e.g. formation of AV fistula
Thrombosis, stenosis
Infection of central catheter

Dialysis disequilibrium - causes cerebral oedema, start HD slowly to avoid
Hypotension
Time consuming

27
Q

Management of CKD (besides RRT)

A

Consider referral to nephrology

Conservative
- Exercise
- healthy weight maintenance
- smoking cessation
- salt restriction

To slow disease progression
- ACEi, ARB
- Control HbA1c e.g. metformin, dapagliflozin

Complications
- anaemia = iron replacement, EPO
- acidosis = sodium bicarbonate
- oedema = loop diuretics (high dose needed)
- bone disease = dietary restriction + phosphate binders, vitamin D supplements
- CVD = statin, anti-platelet (low dose aspirin) if atherosclerotic risk

finals - paces (9 decks)

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