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

Abdo- medicine Flashcards

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

A

ATN following rhabdomyolysis

25
Q

Dapaglifozin - what is it? and what condition can it aggravate?

A

SGLT2 inhibitor Increases urinary glucose excretion –> worsens thrush!

26
Q

Mx of malaria falciparum

A

Stable: quinine Severe: artesunate

27
Q

stages of AKI

A

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
Q

Renal causes of AKI

A

ATN: due to ischemia or deposition of urate/IgG/myoglobin/Hb Glomerulonephritis SLE, sarcoid NSAIDs, Abx, allopurinol

29
Q

Causes of hyperkalemia

A

CKD or AKI Addisons ACEIs Rhabdomyolysis, tumour lysis syndrome, haemolysis

30
Q

Metformin + CKD?

A

Avoid metformin if egfr<30 –> lactic acidosis

31
Q

LMWH + CKD?

A

avoid LMWH if eGFR<30 –> risk of bleeding

32
Q

Opioid analgesia + CKD?

A

Avoid morphine Opt for OXYCODON

33
Q

Urgent dialysis - indications?

A

Acidosis Hyperkalemia Intoxication (aspirin, lithium, methanol) Oedema - pulmonary Uraemia (pericarditis, encephalopathy)

34
Q

Types of renal transplant rejection

A

Hyper acute (hours) Acute (1-12 weeks): cell mediated. - Pain + oliguria Chronic: fibrosis and scarring of transplant vessels

35
Q

Renal transplant immunosuppression?

A

Induction: alemtezumab + basiliximab Maintenance 1) calcineurin inhibitor (tacrolimus, ciclosporin) 2) antimetabolite (azathioprine, MMF) 3) prednisolone

36
Q

Renal causes of AKI

A

ATN: due to ischemia or deposition of urate/IgG/myoglobin/Hb Glomerulonephritis SLE, sarcoid NSAIDs, Abx, allopurinol

37
Q

Causes of hyperkalemia

A

CKD or AKI Addisons ACEIs Rhabdomyolysis, tumour lysis syndrome, haemolysis

38
Q

Metformin + CKD?

A

Avoid metformin if egfr<30 –> lactic acidosis

39
Q

LMWH + CKD?

A

avoid LMWH if eGFR<30 –> risk of bleeding

40
Q

Opioid analgesia + CKD?

A

Avoid morphine Opt for OXYCODON

41
Q

Urgent dialysis - indications?

A

Acidosis Hyperkalemia Intoxication (aspirin, lithium, methanol) Oedema - pulmonary Uraemia (pericarditis, encephalopathy)

42
Q

Types of renal transplant rejection

A

Hyper acute (hours) Acute (1-12 weeks): cell mediated. - Pain + oliguria Chronic: fibrosis and scarring of transplant vessels

43
Q

Mx of Nephrotic syndrome

A

Diuretics (furosemide) ACEis (BP) - prevent complications!!! 1) VTE prophylaxis 2) statin 3) Vaccination for infection

44
Q

3 causes of membraneous GN

A

Hepatitis SLE NSAIDs

45
Q

3 causes of focal segmental glomerulosclerosis

A

HIV DM Amyloid

46
Q

mx of anti-GBM/wegeners

A

IV pred Immunosuppression Plasmapheresis

47
Q

1st line induction treatment in UC?

A

5-ASA (mesalazine/sulfasalazine) +/-steroids

48
Q

1st line maintenance treatment in UC?

A

5-ASA!!!!! Pr/PO (this is also used to induce remission)

49
Q

1st line induction treatment in Crohns?

A

STEROIDS

50
Q

1st line maintenance treatment in Crohns?

A

Azathioprine/Mercaptopurine

51
Q

mx of severe exacerbation of IBD?

A

Admit IV access + ABC resus (fluids) IV hydrocortisone LMWH dietician review +/- ABx

52
Q

Indications for surgery in Crohns disease? Give 6 (emergency and elective)

A

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
Q

Indications for surgery in UC?

A

Emergency: Toxic megacolon Perforation Massive haemorrhage Elective: Failure of medical Mx Malignancy FTT in children

54
Q

Features of short gut syndrome (seen in Crohns, SI <2m)

A

Steatorrhoea Deficiency in Vit ADEK B12 and folate deficiency Gallstones Renal stones

55
Q

Mx of short gut syndrome

A

Dietitian Supplements or TPN Loperamide

56
Q

Food which coeliacs must avoid

A

Barley Rye Oats Wheat

57
Q

Carcinoid tumours - features?

A

Diarrhoea Flushing Wheeze Pellagra - dermatitis, dementia, diarrhoea

58
Q

Mx of carcinoid tumour

A

Octreotide

Yr 6 PACES knowledge COPY RJ Challenger (16 decks)

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