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Abdo Flashcards

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1
Q

What signs of chronic liver disease may be visible on the hands?

A

Palmar erythema
Dupuytren’s contracture
Leuconychia
Clubbing

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2
Q

What disease may be indicated by a greyish skin colour?

A

Haemochromatosis

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3
Q

What signs must you look for to check for decompensation of chronic liver disease?

A

Ascites
Asterixis with ‘liver flap’
Encephalopathy

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4
Q

What are some causes of hepatomegaly?

A

Cirrhosis (alcoholic)
Carcinoma
Congestive cardiac failure
Infection eg Hep B or C
Immune eg PBC, PSC, AIH
Infiltrative eg amyloid or myeloproliferative disorders

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5
Q

What blood tests constitute a ‘liver screen?

A

Autoantibodies and immunoglobulins for PBC/PSC/AIH - ANA, anti smooth muscle, anti-mitochondrial
Hep B and Hep C serology
EBV and CMV serology
Ferritin
Caeruloplasmin
Alpha 1 antitrypsin
AFP for HCC
INR
Albumin
FBC, U&Es, LFTs, glucose

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6
Q

Aside from blood tests, what other investigations should be done in a liver screen?

A

Ulstrasound scan of abdomen
Tap of ascites if present
+/- ERCP/Biopsy

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7
Q

What are some complications of cirrhosis?

A

Variceal haemorrhage
Hepatic encephalopathy
Spontaneous bacterial peritonitis
Hepatorenal syndrome
Hepatocellular carcinoma

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8
Q

What is the Child-Pugh classification and what does it predict?

A

Prognosis of classification in liver cirrhosis, based on bilirubin, INR, albumin, ascites and encephalopathy. Higher score relates to lower chance of survival at 1 year

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9
Q

What are the most common causes of chronic liver disease?

A

Alcoholic cirrhosis
Viral hepatitis
Non-alcoholic fatty liver disease

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10
Q

How is chronic liver disease managed?

A

MDT approach
Abstain from alcohol
Vitamin and thiamine replacement
Optimise nutrition
Salt restriction
Diuretics if ascites
Propanolol if varices
Laxatives for encephalopathy prevention

+/- TIPS/transplantation

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11
Q

What is a TIPS procedure?

A

Transjugular intrahepatic portal shunt. Diverts blood from portal vein to hepatic vein to reduce portal hypertension

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12
Q

What are some common precipitants for decompensation of chronic liver disease?

A

Infection
GI bleed
Increased alcohol intake
Malignancy
Constipation
Dehydration
Hepatotoxic drugs

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13
Q

What are some abdominal causes for finger clubbing?

A

Hepatocellular carcinoma
IBD
Cirrhosis
Coeliac disease

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14
Q

What are some complications of haemochromatosis?

A

Diabetes
Hypogonadism
Congestive cardiac failure
Arthopathy secondary to pseudogout

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15
Q

What is the genetic basis of haemochromatosis?

A

Autosomal recessive with high incidence of heterozygous carriers

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16
Q

How is haemochromatosis diagnosed?

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A

Blood tests - raised ferritin with high transferrin saturation
Liver biopsy

17
Q

What is the definition of massive splenomegaly?

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A

Spleen that crosses the midline and the umbilicus

18
Q

What are some causes of massive splenomegaly?

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A

HIV
Myeloproliferative disorders eg AML CML and myelofibrosis
Infections eg malaria and visceral leishmaniasis

19
Q

What are some causes of moderate splenomegaly?

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A

Myeloproliferative disorders
Lymphoproliferative disorders eg lymphoma and CLL
Infiltrative disorders eg amyloidosis and gaucher’s

20
Q

What are some causes of mild splenomegaly?

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A

Myeloproliferative disorders
Lymphoproliferative disorders
Infections eg epstein barr and viral hepatitis
Infective endocarditis
Portal hypertension
Haemolytic anaemia
Autoimmune conditions eg SLE

21
Q

What are indications for splenectomy?

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A

Rupture due to trauma
ITP
Hereditary spherocytosis

22
Q

What long term management is required following splenectomy?

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A

Vaccination (ideally 2 weeks prior if elective) against encapsulated bacteria, ie pneumococcus
Meningococcus
Haemophilus influenza
Lifelong prophylactic penicillin
Medialert bracelet

23
Q

What is the inheritance pattern of polycystic kidney disease?

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A

Autosomal dominant defect of ADPKD1/2 gene

24
Q

What are some causes of bilateral kidney enlargement?

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A

Polycystic kidney disease
Amyloidosis
Bilateral renal cell carcinoma
Bilateral hydronephrosis
Tuberous sclerosis

25
What are some causes of unilateral kidney enlargement?
Polycystic kidney disease with other kidney either not palpable or resected (look for flank scar) Renal cell carcinoma Simple cysts Hydronephrosis due to ureteric obstruction
26
What are some extra-renal manifestations of polycystic kidney disease?
Polycystic liver disease. Usually asymptomatic but may cause mass effect or haemorrhage/infection Seminal vesicle cysts leading to male infertility Subdural haematoma due to arachnoid membrane cysts Recurrent pancreatitis due to pancreatic cysts Intracranial berry aneurysms Aneurysms elsewhere in vasculature Mitral valve prolapse Aortic root dilataion and valve insufficiency
27
How does polycystic kidney disease present?
Hypertension Haematuria, often after trauma Recurrent UTIs abdominal pain
28
What is the prognosis of adult polycystic kidney disease?
50% end stage renal disease/transplantation by age 60 Increased risk of progression if: afro-carribbean Male Multiple pregnancies Hypertension Large kidneys Younger age of onset
29
How is polycystic kidney disease managed?
Tolvaptan (vasopressin receptor antagonist) approved by NICE for rapidly progressing deterioration of renal dunction starting from CKD 2/3 MDT approach Consider family planning/genetic counselling Modify cardiovascular risk factors Hypertension management Monitor for progression manage symptoms/complications MRA for aneurysms if symptoms/family history of aneurysms/stroke or high risk occupation dialysis/transplant/nephrectomy if anecessary
30
When is nephrectomy indicated in polycystic kidney disease?
Recurrent bleeds or infections or very large size
31
What are some extra-intestinal manifestations of inflammatory bowel disease
Skin - erythema nodosum, pyoderma gangrenosum, apthous ulcers Joints - seronegative arthritis Eyes - uveitis episcleritis, scleritis, conjunctivitis HPB - primary sclerosing cholangitis (esp in UC), cholangiocarcinoma Renal - oxalate stones
32
How should inflammatory bowel disease be investigated?
Stool MC+S and CDiff toxin Faecal calprotectin Bloods, including FBC, CRP, LFTS (inc albumin as marker of severity and lfts for associated liver disease) Flexi sig/colonoscopy and biopsy for diagnosis AXR in acute presentations for ?toxic megacolon
33
How is Crohn's disease managed?
MDT approach including specialist IBD nurses. Induce remission with steroids +/- methotrexate, azathioprine Maintain remission with azathioprine/methotrexate/mercaptopurine Can consider biologic therapy if ongoing active disease eg infliximab Surgery if limited disease/severe flare/refractory disease Nutritional support
34
How is ulcerative colitis managed?
MDT approach including specialist IBD nurses Mesalazine is mainstay, including mesalazine enemas as often purely rectal disease Can add in steroids to induce/maintain remission if needed Surgery potentially curative so consider for severe refractory disease, lifethreatening flares or colorectal cancer
35
What is the genetic basis for tuberous sclerosis?
Mutations of TSC1 (chromosome 9) or TSC 2 (chromosome 16) leading to growth dysregulation via mTORC1 TSC2 mutations are more common and associated with more severe disease.
36
What is the presentation of tuberous sclerosis?
Neurological - seizures - due to cortical tubers, subependymal giant cell astrocytoma-caues mass effect, retinal hamartoma Cutaneous - ash leaf macules, facial angiofibromas, shagreen patches, ungual fibromas Renal -Angiomyolipoma, PKD Pulmonary - lymphangioleiomyomatosis Cardiac - rhabdomyoma May have learning difficulties, autistic spectrum disorder and mood disorders
37
How is renal tuberous sclerosis managed?
Bleeding angiomyolipomas require embolisation Can have everolimus (mTOR inhibitor) to reduce growth of angiomyolipomas and reduce risk of bleed and subsequent loss of kidney function. Monitor and treat risk factors such as BP
38
What are the side effects of tolvaptan?
Polyuria, nocturia, polydipsia, dehydration, liver injury

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