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Yr 6 PACES knowledge COPY RJ Challenger > Abdo- medicine > Flashcards

Abdo- medicine Flashcards

(58 cards)

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1
Q

Causes of ascites

A

3 Cs: Cirrhosis Cardiac failure Cancer

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2
Q

How to determine the cause of ascites?

A

Serum Ascites Albumin Gradient (serum - ascites) >1.1 –> cirrhosis <1.1 –> malignancy, pancreatitis, TB peritonitis

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3
Q

Causes of portal HTN

A

Nephrotic syndrome, PCV (pre hepatic) Cirrhosis (hepatic) Heart failure (post hepatic)

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4
Q

Conservative, medical, surgical management of ascites

A

Conservative: Restrict fluid + Na, monitor weight loss, stop EtOH Medical: spironolactone Surgical: Therapeutic paracentesis

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5
Q

Risk of paracentesis in ascites?

A
  1. Major hypovolemia (must give IV albumin!) 2. Spontaneous bacterial peritonitis
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6
Q

Mx of Spontaneous bacterial peritonitis?

A

Tazocin until sensitivities are known Later: long term ciprofloxacin

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7
Q

Causes of CKD vs causes of Renal transplant

A

CKD: DM, HTN Transplant: DM, Glomerulonephritis, PCKD

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8
Q

Features of CKD

A

ABCEF - Anemia - Acidosis (confusion, SOB) - Bone: Osteitis fibrosis cystica - Clearance - uraemia (confusion, periph neuropathy, restless legs, pericarditis) - Electrolytes - hyperkalemia (palpitations) - Fluid overload - pedal edema, pulmonary edema

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9
Q

Indications for acute dialysis

A

1) Acidosis <7.2 2) Hyperkalemia >7 persistently 3) Pulmonary oedema 4) Uraemia (pericarditis, encephalopathy, peripheral neuropathy)

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10
Q

Management of CKD

A

1) ACEi + statin (unless RAS) 2) Anemia –> EPO (once ACD + IDA are exc) 3) Bone –> phosphate binders, vitD3 4) K+ –> 10mL 10% calcium gluconate + 10U insulin + 100mL 20% dextrose + salbutamol nebs 5) pulm edema –> furosemide 6) restless legs –> clonazepam

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11
Q

Renal transplants: what types of transplant are there? what immunosuppression is given?

A

Types: DCD, DBD, LD Immunosuppression: induction + maintenance Induction = atelezumab Maintenance = triple therapy = Pred + antimetabolite (azathioprine) + calcineurin inhibitor (tacrolimus)

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12
Q

eg of maintenance immunosuppression in renal transplant pt

A

Prednisolone Azathioprine (anti-metabolite) Tacrolimus (calcineurin inhibitor)

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13
Q

Compilations of renal transplant

A

Surgical: - Urinary leak - infection - bleed - thrombosis - rejection (can be acute or chronic) - delayed graft function (in 40%) Immunosuppression: - malignancy - skin SCC + viral assoc - Opportunistic infection: PCP, cryptococcus, Candida - Tremor, gingival hypertrophy, bone marrow suppression

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14
Q

O/E findings of a pt with renal transplant

A

Renal transplant: Rutherford morrison scar w smooth mass + dull PN Hands + arms: - DM finger pricks - (AV fistula or Tesio scar that is no longer used) Bruising, striae, moon face –> cushingoid from immunosuppression Face: - Gingival hypertrophy (cyclosporin) Abdo: Insulin induced lipodystrophy (DM) Huge ballot able kidneys (PCKD) Nephrectomy scars

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15
Q

O/E of a pt with immunosuppression from renal transplant

A

Gingival hypertrophy Tacrolimus tremor Cushingoid appearance

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16
Q

List bare causes for CKD

A

DM, HTN, Glomerulonephritis, PCKD CTD - RA, scleroderma, SLE Amyloidosis RAS Myeloma Pyelonephritis

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17
Q

Ataxia, hallucinations, liver failure , in a young pt

A

wilsons

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18
Q

Dx of wilsons

A

low serum caeruloplasmin high urinary copper

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19
Q

Liver failure DM Impotence Bronzed skin

A

Haemochromatosis

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20
Q

Dx of haemochromatosis

A

serum transferrin is high

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21
Q

Ix in ?haemochromatosis

A

serum transferrin Ferritin LFTs, liver MRI + biopsy Glucose (DM) Echo, ECG (DCM)

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22
Q

Mx of haemochromatosis

A

Low iron diet + low vit C Desferrioxamine HepA + B vaccine

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23
Q

Mx of hepatic encephalopathy

A

Lactulose

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24
Q

Preceding trauma + brown casts in urine

Study These Flashcards
A

ATN following rhabdomyolysis

25
Dapaglifozin - what is it? and what condition can it aggravate?
SGLT2 inhibitor Increases urinary glucose excretion --\> worsens thrush!
26
Mx of malaria falciparum
Stable: quinine Severe: artesunate
27
stages of AKI
1) \<0.5ml/kg/h for 6 hours or Cr \>1.5x baseline 2) "" for 12 hours or Cr 2-2.9x 3) \<0.3 " " for 24 hours or 12 hrs of anuria. Cr \>3x baseline
28
Renal causes of AKI
ATN: due to ischemia or deposition of urate/IgG/myoglobin/Hb Glomerulonephritis SLE, sarcoid NSAIDs, Abx, allopurinol
29
Causes of hyperkalemia
CKD or AKI Addisons ACEIs Rhabdomyolysis, tumour lysis syndrome, haemolysis
30
Metformin + CKD?
Avoid metformin if egfr\<30 --\> lactic acidosis
31
LMWH + CKD?
avoid LMWH if eGFR\<30 --\> risk of bleeding
32
Opioid analgesia + CKD?
Avoid morphine Opt for OXYCODON
33
Urgent dialysis - indications?
Acidosis Hyperkalemia Intoxication (aspirin, lithium, methanol) Oedema - pulmonary Uraemia (pericarditis, encephalopathy)
34
Types of renal transplant rejection
Hyper acute (hours) Acute (1-12 weeks): cell mediated. - Pain + oliguria Chronic: fibrosis and scarring of transplant vessels
35
Renal transplant immunosuppression?
Induction: alemtezumab + basiliximab Maintenance 1) calcineurin inhibitor (tacrolimus, ciclosporin) 2) antimetabolite (azathioprine, MMF) 3) prednisolone
36
Renal causes of AKI
ATN: due to ischemia or deposition of urate/IgG/myoglobin/Hb Glomerulonephritis SLE, sarcoid NSAIDs, Abx, allopurinol
37
Causes of hyperkalemia
CKD or AKI Addisons ACEIs Rhabdomyolysis, tumour lysis syndrome, haemolysis
38
Metformin + CKD?
Avoid metformin if egfr\<30 --\> lactic acidosis
39
LMWH + CKD?
avoid LMWH if eGFR\<30 --\> risk of bleeding
40
Opioid analgesia + CKD?
Avoid morphine Opt for OXYCODON
41
Urgent dialysis - indications?
Acidosis Hyperkalemia Intoxication (aspirin, lithium, methanol) Oedema - pulmonary Uraemia (pericarditis, encephalopathy)
42
Types of renal transplant rejection
Hyper acute (hours) Acute (1-12 weeks): cell mediated. - Pain + oliguria Chronic: fibrosis and scarring of transplant vessels
43
Mx of Nephrotic syndrome
Diuretics (furosemide) ACEis (BP) - prevent complications!!! 1) VTE prophylaxis 2) statin 3) Vaccination for infection
44
3 causes of membraneous GN
Hepatitis SLE NSAIDs
45
3 causes of focal segmental glomerulosclerosis
HIV DM Amyloid
46
mx of anti-GBM/wegeners
IV pred Immunosuppression Plasmapheresis
47
1st line induction treatment in UC?
5-ASA (mesalazine/sulfasalazine) +/-steroids
48
1st line maintenance treatment in UC?
5-ASA!!!!! Pr/PO (this is also used to induce remission)
49
1st line induction treatment in Crohns?
STEROIDS
50
1st line maintenance treatment in Crohns?
Azathioprine/Mercaptopurine
51
mx of severe exacerbation of IBD?
Admit IV access + ABC resus (fluids) IV hydrocortisone LMWH dietician review +/- ABx
52
Indications for surgery in Crohns disease? Give 6 (emergency and elective)
Failure to respond to medical treatment Perforation, fistula Massive haemorrhage Elective: Perianal disease Rest distal bowel (loop ileostomy) Cancer N.B. surgery in Crohns is never curative
53
Indications for surgery in UC?
Emergency: Toxic megacolon Perforation Massive haemorrhage Elective: Failure of medical Mx Malignancy FTT in children
54
Features of short gut syndrome (seen in Crohns, SI \<2m)
Steatorrhoea Deficiency in Vit ADEK B12 and folate deficiency Gallstones Renal stones
55
Mx of short gut syndrome
Dietitian Supplements or TPN Loperamide
56
Food which coeliacs must avoid
Barley Rye Oats Wheat
57
Carcinoid tumours - features?
Diarrhoea Flushing Wheeze Pellagra - dermatitis, dementia, diarrhoea
58
Mx of carcinoid tumour
Octreotide

Yr 6 PACES knowledge COPY RJ Challenger (16 decks)

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