Abdo Flashcards

Question

Diffuse oesophageal spasm

Answer 1

 Intermittent dysphagia ± chest pain |  Ba swallow shows corkscrew oesophagus

Answer 2

 Cushing’s: intracranial disease |  Curling’s: burns, sepsis, trauma

Answer 3

1. Sliding (80%) - gastro-oesophageal junction slides into chest and associated with GORD 2. Rolling (15%) - gastro-oesophageal junction remains in abdomen with bulge into chest and so no GORD as LOS intact; can strangulate. Should repair therefore 3. Mixed (5%) Typically treat reflux and advise to lose weight

Answer 4

Prediction of re-bleeding and mortality in upper GI bleed  40% of re-bleeders die Initial score pre-endoscopy:  Age  Shock: BP, pulse  Comorbidities ``` Final score post-endoscopy:  Final Dx + evidence of recent haemorrhage  Active bleeding  Visible vessel  Adherent clot ``` Initial score ≥3 or final >6 are indications for surgery

Answer 5

 > 2 = EtOH |  < 1 = Viral

Answer 6

↓ albumin in chronic failure | ↑ PT in acute failure

Answer 7

Renal failure in patients with advanced liver failure  Type 1: rapidly progressive deterioration (survival <2wks)  Type 2: steady deterioration (survival ~6mo) Rx:  IV albumin + splanchnic vasoconstrictors (terlipressin)  Haemodialysis as supportive Rx  Liver Tx is Rx of choice

Answer 8

 Bleeding: Vit K, platelets, FFP, blood  Sepsis: tazocin (avoid gent: nephrotoxicity)  Ascites: fluid and salt restrict, spiro, fruse, tap, daily wt  Hypoglycaemia: regular BMs, IV glucose if <2mM  Encephalopathy: avoid sedatives, lactulose ± enemas, rifaximin  Seizures: lorazepam  Cerebral oedema: mannitol

Answer 9

 Avoid: opiates, oral hypoglycaemics, Na-containing IVI  Warfarin effects ↑  Hepatotoxic drugs: paracetamol, methotrexate, isoniazid, salicylates, tetracycline

Answer 10

Types  Cadaveric: heart-beating or non-heart beating  Live: right lobe Can use the Kings College Hospital Criteria in Acute failure which has different criteria depending on whether paracetamol induced or not Immunosuppression:  Ciclosporin / Tacrolimus +  Azathioprine / Mycophenolate Mofetil +  Prednisolone

Answer 11

Predicts risk of bleeding, mortality and need for Tx ``` Graded A-C using severity of 5 factors  Albumin  Bilirubin  Clotting  Distension: Ascites  Encephalopathy ``` Score >8 = significant risk of variceal bleeding

Answer 12

General  Good nutrition  EtOH abstinence: baclofen helps ↓ cravings  Colestyramine for pruritus  Screening for HCC (US and AFP) & Oesophageal varices (endoscopy) Specific  HCV: Interferon-α  PBC: Ursodeoxycholic acid  Wilson’s: Penicillamine

Answer 13

1. left and short gastric veins + infer. oesophageal veins = oesophageal varices 2. peri-umbilical veins + superficial abdominal wall veins = caput medusae 3. Super. rectal veins + inf. and mid. rectal veins = haemorrhoids

Answer 14

More common than caput medusa  Blood flow down below the umbilicus: portal HTN  Blood flow up below the umbilicus: IVC obstruction

Answer 15

 Pre-hepatic: portal vein thrombosis (e.g. pancreatitis)  Hepatic: cirrhosis (80% in UK), schisto (commonest worldwide), sarcoidosis.  Post-hepatic: Budd-Chiari, RHF, constrictive pericarditis, TR ``` Leads to SAVE Splenomegaly Ascites Varices Encephalopathy ```

Answer 16

 1: Confused – irritable, mild confusion, sleep inversion  2: Drowsy – ↑ disorientated, slurred speech, asterixis  3: Stupor – rousable, incoherence  4: Coma – unrousable, ± extensor plantars Important to give lactulose (+/- phosphate enemas) to these patients with encephalopathy

Answer 17

Caused calculated via serum ascites albumin gradient (serum albumin – ascites albumin) If >1.1g/dL = portal HTN ``` If <1.1g/dL = NINI Neoplasia Inflammation (pancreatitis) Nephrotic syndrome Infection (TB) ``` Rx: reduce weight by 0.5kg/d via fluid restriction, spironolactone and frusemide and can drain via paracentesis with HAS infusion

Answer 18

 Group therapy or self-help (e.g. AA)  Baclofen: ↓ cravings  Acamprosate: ↓ cravings  Disulfiram: aversion therapy

Answer 19

Maddrey score predicts mortality  Mild: 0-5% 30d mortality  Severe: 50% 30d mortality  1yr after admission: 40% mortality

Answer 20

 Carrier: 10%  HBsAg +ve > 6mo  Chronic hepatitis: 10%  Cirrhosis: 5% Rx: PEGinterferon

Answer 21

 Carrier: 80%  HCV RNA+ve >6mo  Chronic hepatitis: 80%  Cirrhosis: 20% Rx: PEGinterferon + ribavarin

Answer 22

Presentation  RUQ pain: stretching of Glisson’s capsule  Hepatomegaly  Ascites: SAAG ≥1.1g/dL  Jaundice (and other features of liver failure) Can be from JAK2 mutation analysis; anticoagulate unless varices

Answer 23

Iron removal  Venesection: aim for Hct <0.5  Desferrioxamine is 2nd line General  Monitor DM  Low Fe diet Screening  Se ferritin and genotype  Screen 1st degree relatives Transplant in cirrhosis Venesection returns life expectancy to normal if non-cirrhotic and non-diabetic

Answer 24

 Diet: avoid high Cu foods: liver, chocolate, nuts  Penicillamine lifelong (Cu chelator). SE: nausea, rash, ↓WCC, ↓Hb, ↓plats, lupus, haematuria  Monitor FBC and urinary Cu excretion  Liver Tx if severe liver disease  Screen siblings

Answer 25

Predominantly in early and middle aged women Type 1 is anti-smooth muscle +ve Ix: Raised IgG and LFTs Mx: immunosuppression with pred and azathioprine (steroid sparing) Prognosis: remission in 80% of patients

Answer 26

Intrahepatic bile duct destruction via granulomatous inflammation Jaundice is late sign Ix: antimitochondrial ab and raised IgM and LFTs (ALP), US Liver biopsy shows non-caseating granuloma Rx: ADEK vitamins, UDCA, symptomatic relief for pruritus (naltrexone), diarrhoea and osteoporosis Ultimately need liver transplant with survival of 2 years if jaundice develops

Answer 27

Inflammation and fibrosis of intra- and extra-hepatic ducts. More likely to get abdo pain Increased risk of ascending cholangitis, cholangiocarcinoma and associated with UC and autoimmune hepatitis Ix: pANCA (80%), ANA and SMA; ALP raised ERCP: "beaded" appearance of ducts and biopsy shows fibrous, obliterated cholangitis Rx: ADEK vitamins, UDCA, symptomatic relief for pruritus (naltrexone), diarrhoea Ultimately need liver transplant with 30% recurrence

Answer 28

``` Symmetrical vesicles, extensor surfaces  Esp. elbows Very itchy biopsy shows granular deposition of IgA Rx: gluten free diet or dapsone ```

Answer 29

Common in UK: Coeliac, Chronic pancreatitis, Crohn’s Rarer  ↓Bile: PBC, ileal resection, colestyramine  Pancreatic insufficiency: Ca, CF, chronic panc  Small bowel: resection, tropical sprue, metformin  Bacterial overgrowth: spontaneous, post-op blind loops, DM, PPIs  Infection: Giardia, Strongyloides, Crypto parvum  Hurry: post-gastrectomy dumping

Answer 30

Thrombophlebitis migrans in cancer, e.g. pancreatic cancer

Answer 31

``` Drugs  Analgesia: may need coeliac plexus block  Creon  ADEK vitamins  DM Rx Diet  No EtOH  ↓ fat, ↑ carb Surgery - Pancreatectomy  Ind: unremitting pain, wt. loss ```

Answer 32

 ↑ urine 5-hydroxyindoleacetic acid  ↑ plasma chromogranin A  CT/MRI: find primary; can be appendix, ileum, colorectum, stomach

Answer 33

Symptoms: octreotide or loperamide Curative  Resection: tumours are v. yellow  Give octreotide to avoid carcinoid crisis Carcinoid Crisis  Tumour outgrows blood supply or is handled too much → massive mediator release  Vasodilatation, hypotension, bronchoconstriction, hyperglycaemia  Rx: high-dose octreotide

Answer 34

 Dry conjunctivae, develop spots (Bitots spots)  Corneas become cloudy then ulcerate  Night blindness → total blindness

Answer 35

 Wet: heart failure + oedema  Dry: polyneuropathy  Wernicke’s: ophthalmoplegia, ataxia, confusion

Answer 36

 Diarrhoea, Dermatitis, Dementia  Also: neuropathy, depression, ataxia  Causes: dietary, isoniazid, carcinoid syndrome

Answer 37

 Peripheral sensory neuropathy |  Cause: PZA

Answer 38

Glossitis → sore tongue Peripheral neuropathy  Paraesthesia  Early loss of vibration and proprioception → ataxia Subacute Combined Degeneration of spinal Cord  Dorsal and corticospinal tracts  Sensory loss and UMN weakness Overall mixed UMN and LMN signs with sensory disturbance  Extensor plantars + absent knee and ankle jerks

Answer 39

in macula densa

Answer 40

At cortical Collecting ducts | controlled by aquaporin-2 channels

Answer 41

 MOA: inhibit carbonic anhydrase in PCT (which reabsorbs carbonic anhydrase)  Effect: ↓ HCO3 reabsorption → small ↑ Na loss  Use: open angle glaucoma  SE: drowsiness, renal stones, metabolic acidosis

Answer 42

 MOA: inhibit Na/K/2Cl symporter in thick ascending limb  Effect: massive NaCl excretion, Ca and K excretion, creating a weaker gradient so water not reabsorbed  Use: Rx of oedema – CCF, nephrotic syndrome, hypercalcaemia  SE: hypokalaemic met alkalosis, ototoxic, Hypovolaemia

Answer 43

 MOA: inhibit NaCl co-transporter in DCT  Effect: moderate NaCl excretion, ↑ Ca reabsorption  Use: HTN, ↓ renal stones, mild oedema  SE: ↓K, hyperglycaemia, ↑ urate (C/I in gout)

Answer 44

 MOA:  Spiro: aldosterone antagonist  Amiloride: blocks DCT/CD luminal Na channel  Effect: ↑ Na excretion, ↓K and H excretion  Use: used with loop or thiazide diuretics to control K loss, spiro has long-term benefits in aldosteronsim (LF, HF)  SE: ↑K, anti-androgenic (e.g. gynaecomastia)

Answer 45

 MOA: freely filtered and poorly reabsorbed  Effect: ↓ brain volume and ↓ ICP  Use: glaucoma, ↑ICP, rhabdomyolysis  SE: ↓Na, pulmonary oedema, n/v

Answer 46

myoglobin, porphyria

Answer 47

Bence-Jones proteins

Answer 48

``` SNIPPIN Stone Neoplasm Inflammation: stricture Prostatic hypertrophy Posterior urethral valve Infection: TB, shisto Neuro: post-op, neuropathy ```

Answer 49

1. Protein loss and Na retention (HTN and overload) 2. Acidosis (Kussmaul respiration) 3. Hyperkalaemia 4. Anaemia 5. Uraemia (need GFR <15ml/min)

Answer 50

```  TB  Treated UTI  Appendicitis  Calculi  TIN  Papillary necrosis  Polycystic Kidney  Chemical cystitis (e.g. cyclophosphamide) ```

Answer 51

 Uncomplicated: normal GU tract and function  Complicated: abnormal GU tract, outflow obstruction, ↓ renal function, impaired host defence, virulent organism  Recurrent: further infection with new organism  Relapse: further infection with same organism

Answer 52

1st line: Cefotaxime 1g IV BD for 10d |  No response: Augmentin 1.2g IV TDS + gentamicin

Answer 53

```  Idiopathic  Immune: SLE, Goodpastures, vasculitis (e.g. Wegener's)  Infection: HBV, HCV, Strep, HIV  Drugs: penicillamine, gold  Amyloid ``` Can present with: 1. asymptomatic haematuria 2. nephrotic syndrome 3. nephritic syndrome

Answer 54

1. IgA Nephropathy (Berger's) - typically in young males few days post URTI with raised IgA. Rx = steroids or cyclophosphamide if renal function impaired. ESRF in 20% after 20 years 2. Thin basement membrane disease - AD and commonest causes. Very small risk of ESRF 3. Alport's syndrome - X-linked. Progressive renal failure, deafness and cataracts; in female haematuria only

Answer 55

Triad of: Haematuria; proteinuria (oedema); HTN Causes: 1. Proliferative/post-strep 2. Crescentic / RPGN

Answer 56

``` Features  Young child develops malaise and nephritic syndrome with smoky urine 1-2wks after sore throat or skin infection.  ↑ ASOT  ↓C3 Biopsy: IgG and C3 deposition Rx: Supportive ``` Prognosis  95% of children recover fully

Answer 57

Type 1: Anti-GBM (Goodpasture’s) – 5%  Haematuria and haemoptysis  CXR shows infiltrates  Rx: Plasmapheresis and immunosuppression Type 2: Immune Complex Deposition – 45%  Complication of any immune complex deposition e.g. Berger’s, post-strep, endocarditis, SLE Type 3: Pauci Immune (ANCA) – 50%; i.e. no features of systemic vasculitis  cANCA: Wegener’s  pANCA: microscopic polyangiitis, Churg-Strauss  Even if ANCA+ve, may still be idiopathic

Answer 58

Primary: 1. Minimal change - associated with URTI in children, biopsy shows normal light micro and fusion of podocytes on EM. Rx = steroids 2. Membranous nephropathy - biopsy shows subepithelial immune complex deposits. Rx = immunosuppression if RF declines, but 40% have spontaneous remission 3. Focal Segmental Glomerulosclerosis - common in Afro-Cari; biopsy shows focal scarring and IgM depositions. Rx = steroids or cyclophosphamide/ciclosporin 4. Membranoproliferative - rare and associated with HBV, HCV and endocarditis; 50% develop ESRF Secondary:  DM: glomerulosclerosis  SLE: membranous  Amyloidosis In general, if symptomatic / complications give frusemide and salt + fluid restrict, give ACEi for proteinuria

Answer 59

AEIOU 1. acidosis <7.2 2. Electrolytes - refractory hyperkalaemia >6.5 3. Intoxication (SLIME toxins) - salicyclates, lithium, isopropanol, methanol, ethyl glycerol 4. oedema (pulmonary) 5. uraemia - leading to encephalopathy or pericarditis

Answer 60

 10ml 10% calcium gluconate  50ml 50% glucose + 10u insulin (Actrapid)  Salbutamol 5mg nebulizer  Calcium resonium 15g PO or 30g PR  Haemofiltration (usually needed if anuric)

Answer 61

 Sit up and give high-flow O2  Morphine 2.5mg IV (± metoclopramide 10mg IV)  Frusemide 120-250mg IV over 1h  GTN spray ± ISMN IVI (unless SBP <90)  If no response consider: CPAP +/- Haemofiltration / haemodialysis ± venesection

Answer 62

Abdominal:  SBO  Anastomotic stricture  Pelvic abscess ``` Stoma:  retraction  stenosis  prolapse  dermatitis ``` Pouch  Pouchitis (50%): metronidazole + cipro  ↓ female fertility  Faecal leakage

Answer 63

``` Drug hypersensitivity in 70%:  NSAIDs  Abx: Cephs, penicillins, rifampicin, sulphonamide  Diuretics: frusemide, thiazides  Allopurinol  Cimetidine ``` Infections in 15%:  Staphs, streps Immune disorders:  SLE, Sjogren’s

Answer 64

Presentation: [] AKI, uveitis, fever, arthralgia, rashes [] elevated IgE and eosinophilia [] dip: haematuria, proteinuria, sterile pyuria Rx: [] stop offending drug [] prednisolone Prognosis - most recover GFR

Answer 65

``` Fibrosis and tubular loss Commonly caused by:  Reflux and chronic pyelonephritis  DM  SCD or trait ```

Answer 66

Prolonged heavy ingestion of compound analgesics Features  Sterile pyuria ± mild proteinuria  Slowly progressive CRF  Sloughed papilla can → obstruction and renal colic Ix: CT w/o contrast (papillary calcifications) Rx: stop analgesics

Answer 67

``` NSAIDs Antimicrobials: AVASTA  Aminoglycosides  Vancomycin  Aciclovir  Sulphonamides  Tetracycline  Amphotericin ACEi Immunosuppressants:  Ciclosporin  Tacrolimus Contrast media Anaesthetics: enflurane Myoglobin Urate ```

Answer 68

Common  DM  HTN ``` Other  RAS  GN  Polycystic disease  Drugs: e.g. analgesic nephropathy  Pyelonephritis: usually 2O to VUR  SLE  Myeloma and amyloidosis ```

Answer 69

``` CRF HEALS  Cardiovascular disease  Renal osteodystrophy - sevelamer is phosphate binder; give calcium supplements  Fluid (oedema)  HTN  Electrolyte disturbances: K, H  Anaemia - EPO raised to 11 (any higher is thrombosis risk)  Leg restlessness - clonazepam  Sensory neuropathy ```

Answer 70

 Active infection  Cancer  Severe HD or other co-morbidity  Pre-op: alemtuzumab (anti-CD52)  Post-op: prednisolone short-term and tacro/ciclo long term

Answer 71

``` Post-op  Bleeding  Graft thrombosis  Infection  Urinary leaks ``` Hyperacute rejection (minutes)  ABO incompatibility  Thrombosis and SIRS Acute Rejection (<6mo)  ↑ing Cr (± fever and graft pain)  Cell-mediated response  Responsive to immunosuppression Chronic Rejection (>6mo)  Interstitial fibrosis + tubular atrophy  Gradual ↑ in Cr and proteinuria  Not responsive to immunosuppression Ciclosporin / tacrolimus nephrotoxicity  Acute: reversible afferent arteriole constriction → ↓GFR  Chronic: tubular atrophy and fibrosis ↓ Immune Function  ↑ risk of infection: opportunists, fungi, warts  ↑ risk of malignancy: BCC, SCC, lymphoma (EBV) Cardiovascular Disease  Hypertension and atherosclerosis

Answer 72

Can cause ARF / CRF; amyloidosis Rx - ensure fluid intake of 3L/d to prevent further impairment Dialysis may be required in ARF

Answer 73

 NSAIDs → ATN  Penicillamine and gold → membranous GN  AA amyloidosis occurs in 15%

Answer 74

 Involves glomerulus in 40-60% → ARF/CRF  Proteinuria and ↑BP common Rx  Proteinuria: ACEi  Aggressive GN: immunosuppression

Answer 75

Renal crisis: malignant HTN + ARF. Commonest cause of death |  Rx: ACEi if ↑BP or renal crisis

Answer 76

Features = hyperchloraemic met acidosis; hypokal Type 1 (Distal) Inability to excrete H+, even when acidotic. Causes  Hereditary: Marfan’s, Ehler’s Danlos  AI: Sjogren’s, SLE, thyroiditis  Drugs Features  Rickets / osteomalacia (bone buffering)  Renal stones and UTIs  Nephrocalcinosis → ESRF Dx - Failure to acidify urine (pH >5.5) despite acid load Type 2 (Proximal) Defect in HCO3 reabsorption in PCT usually assoc. Fanconi syndrome Dx - Urine will acidify with acid load (pH <5.5)

Answer 77

Disturbance of PCT function → generalised impaired reabsorption  amino acids, K+, HCO3, phosphate, glucose Features:  Polyuria (osmotic diuresis)  Hypophosphataemic rickets (Vit D resistant)  Acidosis, ↓K

Answer 78

Blockage of NaCl reabsorption in loop of Henle (like frusemide) Hypokalaemia and met alkalosis with normal BP with salt wasting

Answer 79

Blockage of NaCl reabsorption in DCT (like thiazides) | hypokalaemia and metabolic alkalosis + hypocalciuria with normal BP

Answer 80

``` MISSHAPES  Mass: abdo mass and flank pain  Infected cyst  Stones  SBP ↑  Haematuria or haemorrhage into cyst  Aneurysms: berry → SAH  Polyuria + nocturia  Extra-renal cysts: liver  Systolic murmur: mitral valve prolapse ``` PKD1 is Chr16, polycystin 1 PKD2 is Chr4, polycystin 2 Recessive PKD you get congenital hepatic fibrosis as well

Answer 81

``` General  ↑ water intake, ↓ Na, ↓ caffeine (may ↓ cyst formation)  Monitor U+E and BP  Genetic counselling  MRA screen for Berry aneurysms ``` Medical  Rx HTN aggressively: <130/80 (ACEi best)  Rx infections Surgical  Pain may be helped by laparoscopic cyst removal or nephrectomy. ESRF in 70% by 70yrs  Dialysis or transplant

Answer 82

Multiple cystic dilatations of the CDs in the medulla, in young females. Renal function usually normal but can predispose to stones

Answer 83

 AD condition with hamartomas in skin, brain, eye, kidney  Skin: nasolabial adenoma sebaceum, ash-leaf macules, peri-ungual fibromas  Neuro: ↓IQ, epilepsy  Renal: cysts, angiomyolipomas

Answer 84

``` PHONOS  Polycystic kidneys: ADPKD, ARPKD, TS  Hypertrophy 2O to contralateral renal agenesis  Obstruction (hydronephrosis)  Neoplasia: RCC, myeloma, amyloidosis  Occlusion (renal vein thrombosis)  Systemic: early DM, amyloid ```

Answer 85

A discoloration of the skin resulting from bleeding underneath, leading to bruising

Answer 86

renal malignancy due to compression of the renal vein between the abdominal aorta and the superior mesenteric vein - known as the nutcracker angle

Answer 87

PTEN mutation and intestinal hamartomas

Answer 88

``` FBC U&E ESR and CRP Coeliac screen Faecal calprotectin ```

Answer 89

Luminal: [] Impacted faeces [] Foreign body Intramural: [] Colorectal carcinoma* [] Diverticular stricture* [] Crohn's stricture Extramural: [] Sigmoid volvulus* [] Caecal volvulus [] Adhesions and hernias (rare in LBO)

Answer 90

Luminal: [] foreign body [] gallstones ``` Intramural: [] Crohn's strictures [] Small bowel tumour [] Congenital atresia [] Malignancy (rare in SMO) ``` ``` Extramural: [] Adhesion* [] Hernia* [] Intussusception [] Small bowel volvulus ``` *Common causes

Abdo Flashcards

(114 cards)