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Sarah's Yr6 PACES > Abdo > Flashcards

Abdo Flashcards

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1
Q

Signs of CLD on general inspection

A

Cachexia
Icterus
Excoriation
Bruising

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2
Q

Signs of CLD in hands

A

Leuconychia
Clubbing
Dupuytren’s contracture
Palmar erythema

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3
Q

Signs of CLD in face

A

Xanthelasma
Parotid swelling
Fetor hepaticus

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4
Q

Signs of CLD on inspection of chest and abdomen

A

Spider naevi and caput medusa
Reduced body hair
Gynaecomastia
Testicular atrophy

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5
Q

How to examine hepatomegaly

A

Mass in RUQ that moves with respiration, that you are not able to get above and is dull to percussion

Estimate size as finger breadths below diaphragm

Smooth or craggy/nodular

Pulsatile (TR in CCF)

Bruit over liver (hepatocellular carcinoma)

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6
Q

General inspection evidence of underlying causes of hepatomegaly

A

Tattoos and needle marks –> infectious hepatitis
Slate-grey pigmentation –> haemochromatosis
Cachexia –> malignancy
Mid-line sternotomy scar –> CCF

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7
Q

Evidence of decompensation in CLD

A

3As
Ascites
Asterixis
Altered consciousness

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8
Q

Causes of hepatomegaly

A 
3Cs and 3Is
Cirrhosis (alcoholic)
Carcinoma (secondaries)
Congestive cardiac failure
Infectious (HBV, HCV)
Immune (PBC, PSC, AIH)
Infiltrative (amyloid and myeloproliferative)
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9
Q

Investigations for CLD patient

A

Bloods: FBC, clotting, U+E, LFT, glucose
USS abdomen
Tap ascites

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10
Q

Investigations for cirrhosis

A

Liver screen bloods:

  • Autoantibodies and immunoglobulins (PBC, PSC, AIH)
  • Hepatitis B and C serology
  • Ferritin (haemochromatosis)
  • Caeruloplasmin (Wilson’s)
  • Alpha-1 antitrypsin
  • AFP (hepatocellular carcinoma)

Hepatic synthetic function:

  • INR
  • Albumin

Liver biopsy

ERCP

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11
Q

Ix for suspected liver malignancy

A

Imaging: CXR and CT abdo/chest
Colonoscopy/gastroscopy
Biopsy

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12
Q

Complications of cirrhosis

A

Variceal haemorrhage due to portal hypertension
Hepatic encephalopathy
Spontaneous bacterial peritonitis

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13
Q

Causes of ascites

A

3Cs
Cirrhosis (80%)
Carcinomatosis
CCF

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14
Q

Treatment of ascites in cirrhotics

A

Abstinence from alcohol
Salt restriction
Diuretics (aim for 1kg weight loss/day)
Liver transplantation

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15
Q

Causes of palmar erythema

A 
Cirrhosis
Hyperthyroidism
RA
Pregnancy
Polycythaemia
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16
Q

Causes of gynaecomastia

A 
Physiological: puberty and senility
Kleinfelter's syndrome
Cirrhosis
Drugs e.g. spironolactone, digoxin
Testicular tumour/orchidectomy
Endocrinopathy e.g. hyper/hypothyroidism and Addisions
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17
Q

PBC antibodies

A

Anti-mitochondrial antibody

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18
Q

PSC antibodies

A

ANA

Anti-smooth muscle

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19
Q

AIH antibodies

A

Anti-smooth muscle
Anti-liver/kidney microsomal type 1 (LKM1)
ANA

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20
Q

Clinical signs of haemochromatosis

A

Increased skin pigmentation (slate-grey)
Stigmata of CLD
Hepatomegaly

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21
Q

Possible scars in haemochromatosis

A

Venesection
Liver biopsy
Joint replacement
Abdominal rooftop incision (hemihepatectomy for HCC)

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22
Q

Complications of haemochromatosis

A

Endocrine: bronze diabetes, hypogonadism, testicular atrophy

Cardiac: CCF

Joints: arthropathy (pseudogout)

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23
Q

Inheritance of haemochromatosis

Study These Flashcards
A

AR

HFE gene mutation - regulates gut iron absorption

24
Q

Presentation of haemochromatosis

Study These Flashcards
A

Fatigue and arthritis
CLD
Incidental diagnosis/family screening

25
Investigations for haemochromatosis
``` Iron studies: increased serum ferritin and transferrin saturation Blood glucose ECG, CXR, Echo Liver USS, AFP, liver biopsy (for HCC) Genotyping ```
26
Treatment for haemochromatosis
``` Regular venesection (1 unit at a time) Avoid alcohol Surveillance for HCC ```
27
Haemochromatosis prognosis
200x increased risk of HCC and reduced life expectancy if cirrhotic Normal life expectancy without cirrhosis + effective treatment
28
How to describe splenomegaly
LUQ mass that moves inferomedially with respiration, has a notch, dull to percuss, cannot get above or ballot Check for hepatomegaly
29
Signs of underlying cause of splenomegaly
Lymphadenopathy --> haematological/infective Stigmata of CLD --> cirrhosis with portal HTN Splinter haemorrhages, murmur --> bacterial endocarditis Rheumatoid hands --> Felty's syndrome
30
Causes of massive splenomegaly (>8cm)
Myeloproliferative disorders - CML, myelofibrosis | Tropical infections - malaria, visceral leishmaniasis
31
Causes of moderate splenomegaly (4-8cm)
Myelo/lymphoproliferative disorders | Infiltration (Gaucher's and amyloidosis)
32
Causes of minor splenomegaly (<4cm)
Myelo/lymphoproliferative disorders Portal hypertension Infections (EBV, IE, infective hepatitis) Haemolytic anaemia
33
Investigations for splenomegaly
``` USS abdomen FBC and film Thick and thin films (malaria) Viral serology CT chest and abdomen Bone marrow aspirate and trephine Lymph node biopsy ```
34
Indications for splenectomy
Rupture (trauma) | Haematological (ITP and HS)
35
Splenectomy work-up
Vaccination (ideally 2/52 prior to protect against encapsulated bacteria): - Pneumococcus - Meningococcus - Hib Lifelong prophylactic penicillin Medic alert bracelet
36
Peripheral signs of renal disease
Hypertension AV fistulae Tunnelled dialysis line Immunosuppressant stigamata e.g. Cushingoid (steroids), gum hypertrophy (ciclosporin)
37
Abdominal signs of renal disease
Palpable kidney - ballotable, can get above it, moves with respiration Polycystic kidney - both palpable (unless one removed), grossly enlarged, 'cystic' or nodular Iliac fossae - scar +/- transplanted kidney Ask to dip urine - proteinuria and haematuria Ask to examine external genitalia - varicocele in males
38
Causes of unilateral kidney enlargement
PCKD (other kidney not palpable or contralateral nephrectomy with flank scar) Renal cell carcinoma Simple cysts Hydronephrosis due to ureteric obstruction
39
Causes of bilateral kidney enlargement
``` PCKD Bilateral renal cell carcinoma (5%) Bilateral hydronephrosis Tuberous sclerosis (renal angiomyolipomata and cysts) Amyloidosis ```
40
Investigations for renal enlargement
``` U+E Urine cytology USS abdomen +/- biopsy IVU CT is carcinoma suspected Genetic studies (ADPKD) ```
41
Presentation of ADPKD
Hypertension, recurrent UTIs, abdo pain (bleeding and infection in cysts), haematuria End-stage renal failure by age 40-60 Other organ involvement: - Hepatic cysts and hepatomegaly - Berry aneurysms - Mitral valve prolapse
42
Treatment for PCKD
Genetic counselling and family screening (10% are new mutations) Nephrectomy for recurrent bleeds/infection/size Dialysis Renal transplantation
43
Evidence of ciclosporin use
Gum hypertrophy | Hypertension
44
Evidence of steroid use
Cushingoid appearance Thin skin Ecchymoses
45
Top 3 reasons for liver transplantation
Cirrhosis Acute hepatic failure (hep A and B, paracetamol OD) Hepatic malignancy (HCC)
46
Causes of gum hypertrophy
``` Drugs: ciclosporin, phenytoin, nifedipine Scurvy Acute myelomonocytic leukaemia Pregnancy Familial ```
47
Skin signs in transplant patients
Malignant: Actinic keratoses (dysplastic change) SCC (100x risk) BCC and malignant melanoma (10x risk) Infective: Viral warts Cellulitis
48
Signs of renal patient on inspection
Arms: AV fistulae (working, currently in use, failed?) Neck: tunnelled dialysis line, scars from previous line Abdo: flank scar (nephrectomy), iliac fossa scar (kidney transplant), peritoneal dialysis catheter/scars (two scars below and lateral to umbilicus) Legs: peripheral oedema
49
Three things to consider when examining a renal patient
1. Underlying reason for renal failure 2. Current treatment modality 3. Complications of past/current treatment
50
Signs of underlying reason for renal failure
Polycystic kidneys - ADPKD Visual impairment, fingerprick marks, injection sites/pumps - diabetes Sclerodactyly, typical facies - systemic sclerosis Rheumatoid hands, nodules - RA (Hepato)splenomegaly - amyloidosis Other organ transplant (liver/heart/lungs) - calcineurin inhibitor nephrotoxicity Ungual fibromata, adenoma sebaceum, polycystic kidneys - tuberous sclerosis
51
Evidence of current treatment modality in renal patient
Haemodialysis: working fistula, tunnelled neck lines, AV grafts Peritoneal dialysis: abdominal catheter Functioning transplant: no evidence of other current dialysis access (in use)
52
Side effects of immunosuppressive treatment in transplant patients
``` Fine tremor - tacrolimus Steroid side effects Gum hypertrophy - ciclosporin HTN - ciclosporin, tacrolimus Skin damage and malignancy - ciclosporin and azathioprine ```
53
Signs of kidney-pancreas transplantation
Lower midline abdominal incision with palpable kidney in iliac fossa (but no overlying scar) Evidence of previous diabetes e.g. visual impairment Younger patient (often 30-40s)
54
Top 3 causes of renal transplantation
Glomerulonephritis Diabetic nephropathy ADPKD
55
Problems following transplantation
Rejection - acute or chronic Infection 2' to immunosuppression - Pneumocystis carinii, CMV Increased risk of other pathology - skin malignancy, post-transplant lymphoproliferative disease, HTN and hyperlipidaemia Immunosuppressant drug SE/toxicity Recurrence of original disease Chronic graft dysfunction

Sarah's Yr6 PACES (3 decks)

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