Abdo Flashcards by Sarah Grantham-Hill

Blood test for the investigation of chronic liver disease

LFT 
MCV 
HEP B &amp; Hep C serology 
Lipids - NASH 
AutoAb: anti smooth muscle, anti-mithochondrial antibody, pANCA, ANA 
IG: total IgG and total IgM 
Genetic: caeruloplasmin, ferritin, a1AT 
Cancer: AFP, CA-19.9

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Complications of chronic liver disease

Increased pressure: varicies, ascites
Decreased synthetic fucntion of liver: coagulapathy, encephalopathy, hypoglycaemia
Sepsis/ spontaneous bacterial perotinits
Hepatorenal syndrome

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Child Pugh grading of cirrhosis

Albumin 
Bilirubin
Clotting 
Distension - ascites 
Encephalopathy

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Precepitants of hepatic liver disease decompensation

HEPATICS 
Heamorrhage e.g varcies
Electrolyte disturbance 
Poisons: diuretics, sedative, anaesthesia 
Alcohol 
Tumour - hepatocellualr carcinoma 
Infections: SBP, pneumonia, UTI, Hep D 
Constipation - commonest cause 
Sugar/ glucose e.g. Low calorie diet

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Presentation of hepatic encephalopathy

Asterixis
Ataxia 
Confusion 
Dysathria 
Constructional apraxia

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Management of hepatic encephalopathy

Nurse in a well lit calm environment 
Correct any preciptiants 
Avoid sedatives 
Lactulose: decreased nitrogen forming bowel bacteria, aim for 2-4 soft stools a day 
Rifaximin PO: kill intestinal microflora

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Poor prognostic factors in chronic liver disease

Worsening encephalopathy
Increased age
Decreased albumin
Increased INR

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Cause of ascites

3 commonest: 3c
Cirrhosis
Congestive cardiac failure
Carcinomatosis

Serum ascites- albumin gradient
Greater or equal to 1.1 = portal HTN

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What is portal HTN

Portal pressure >10mmHg

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Indications for therepeutic paracentesis

Resp compromise
Pain/discomfort
Renal impairment

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Causes of jaundice

Pre- hepatic : Unconjugated
- heamolysis: autoimmune haemolytic anemia, hereditary spheroctyosis, sickle cell disease
-uncommon: PND, MAHA, malaria, G6PD
- ineffective erythropoesis e.g sickle cell disease
Hepatic
- common: chronic liver disease, alcoholic hepatitis, viral hepatitis, drugs( paracetamol, statins, anti-TB)
- rarer cause: congenital, autoimmune, cancer primary or secondary, vascular e.g. Budd chiari, decreased bilirubin excretion e.g Dublin Johson syndrome

Post- hepatic

common: gallstone, cancer of the head of the pancreas, lymph nodes at the porta hepaptis e.g. Cancer, TB
rarer: PBC, PSC, Cholangiocarcinoma, drugs: OCP, Augmentin and flucoxacillin

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Differential for a Mercedes Benz scar

Liver transplant
Liver segmental resection
Whipples: pacreaticduedenectomy

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Contraindication to liver transplantion

Extra-hepatic malignancy 
Severe cardiorepsitiory disease 
Systemic sepsis 
HIV infection
Non compliance with drug therapy

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Indication for liver transplantation

Recuurent variceal haemorrhage 
Intractable ascites 
SBP 
Refactory encephalopathy 
Severe jaundice 
Declining synthetic function 
Sudden detioration 
Fulminant hepatic failure

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King’s college criteria for liver transplantation in paracetamol liver failure

Arterial pH 300mol

- grade III or IV encephalopathy

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Liver edge characteristic and cause

Smooth: venous congestion and fatty infiltration
Knobbly: metastase, cyst 
Pulsatile: tricuspid regurgitation 
Tender: hepatitis, RHF - capsular pain 
Bruit: HCC, AV malformation, TIPPS

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Examination finding in heamochromatosis

Hepatic: hepatomegaly, cutaneous stigmata of liver disease, signs of portal HTN
MSK: athritis and joint swelling
Cardiac: dilated cardiomyopathy (SOB, Odema, raised JVP) Arrhythmia
Derm: slate grey or bronzing pigmentation ( due to melanin and iron depositon, scars in ACF (venesection), hair loss
Hypogonadism: testicular atrophy, loss of axillary and pubic hair
Hypothyroidism

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Fucntion of the spleen

Phagocytosis of old RBC/WCC 
Phagocytosis of opsonised bugs - paticualry encapsulated organs 
Ab production
Sequestration of formed blood elements 
Haematopoiesis

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Immunisation post spleenectoy

Pneumovax
HIB
MEN C
Yearly flu

Differential of enlarged kidneys

Bilateral 
- ADPKD 
- bilateral renal cell carcinoma 
- bilateral cysts e.g Von hippel Lindau 
- tuberous sclerosis 
- Amyloidosis 
Unilateral 
- simple renal cyst 
- renal cell carcinoma 
- compensatory hypetrophy 
- contralatela nephrectomy

Triad of renal cell presentation

Heamaturia, loin pain, loin mass

Paraneoplastic features of renal cell carcinoma

EPO- polycythemia 
PTHrp - increased calcium 
Renin- HTN 
ACTH - Cushing syndrome 
Amyloidosis

Contraindication to renal transplant

Active infection
Cancer in the proceeding 2yrs
Severe co-morbidity - paticualry cvs
Failed pre-implantation cross match

Type of renal transplants

Deceased
- brain stem death with cardioveric support
- non- heart beating donar
Live - related or unrelated

Complication of renal transplants

Post-op: bleeding, graft thrombosis, infection, urinary leaks, hyper acute rejection Rejection - acute or chronic Disease reoccurrence Drug toxicity Increased risk of infection: CMV, pcp, funghi, warts Increased risk of malignancy: skin and post transplant lymphoprfolivarive disease

Indication for renal replacement

GFR

Complication of dialysis

``` 20% annual mortality CVD Malnuturiton Infection Amyloidosis Renal cyst- renal cell carcinoma ```

Disequilibration syndrome

Occurs after dialysis - rapid change in plasma osmallity leads to cerebral odema

Definition of an AV Fistula

Surgically created connection between atery and vien

Complication of fistula

``` Thrombosis Stenosis Infection Bleeding Anneyserusm ```

Classification of chronic renal failure

``` CKD 1 = eGFR >90 - but other evidence of renal damage CKD 2 = eGFR 60-90 CKD 3 = eGFR 30-59 CKD 4 = eGFR 15-29 CKD 5 = eGFR ```

Indications for acute dialysis

pH 7mM Intoxicatin - digoxin or aspirin Refractory pulmonary odema Pericarditis or encephalopathy secondary to uraemia

Cause of chronic renal failure

Common: diabetes and HTN Vascular: renal artery stenosis, vasculitides Infective: pyelonephritis Inflammatory: SLE, sarcoid, RA Gentic: autosomal dominant polycystic kidney disease Drugs e.g. Analgesic neuropathy Inflitrative: myeloma, Amyloidosis

Complications of chronic renal failure

``` Cardiovascular disease Renal osteodystrophy Fluid - odema Hypertension Electrolyte disturbance - potassium and hydrogen Anemia Legs restless Sensory neuropathy ```

Pathological hallmark of diabetic nephropathy

``` Glomeruloscelerosis Nephrons loss ( leads to HTN) ```

3 ways in which rheumatoid can cause CKD

NSAID leading to acute tubuointersirin necrosis Penecillamine and Gold leading to membranous GN AA Amylodidosis in 15 %

Nephrotic syndrome feature

Protienuria Hypoalbuimiea Odema Hyperlipidemia

Cause of nephrotic syndrome

``` Primary - minimal change disease - membranous glomerlous nepthropahty - focal segmental glomerluloscleoris - membranous proliferative glomerulonephritis Secondary - diabetes, amyloid ```

Cause of nephrotic

1. Proliferative/post strep glomerulonephritis 2. Cresenteric / rapidly progressive glomerluonephritis - 3 types: 1. Type 1: Goodpastures e.g. Anti-GBM 2. Type 2: immune complex mediated - SLE, post infectious 3. IgA nepthropathy

True-love and witts criteria for exacerbation of IBD

``` Syptoms - bowel movement >6 times a day - large PR bleed Systemic signs: HR > 90 pyrexia >37.8 Lab values: hb 30mm/HR ```

Induction of UC

1. 5-ASA 2. Prednisolone 3. Ciclosporin/ infliximab Or topical enema

Maintaince of UC

1. 5- ASA 2. Azothiorpine 3. TNF inhibitors

Chrons induction

1. Ileocecal - budesonide, colitis - sulfasalazine 2. Prednisolone 3. Methotrexate 4. Infliximab/adalimunmab

Maintaince of chrons

1. Azothioprine 2. Methotrexate 3. Infliximab

Detention of achalasia

Focal motility disorder of the oseophagus caused by degeneration of the myenteric plexus of Auerbach