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Abdominal Flashcards

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1
Q

Most likely causes of hepatomegaly?

3Cs, 4Is

A

Carcinoma
Cirrhosis
CCF
Immune (PBC, PSC, Hepatitis)
Infiltrative (amyloid, myeloproliferative)
Iron - haemochromatosis
Infective - viral hepatitis

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2
Q

What bloods would you want to Ix hepatomegaly?

A

FBC, U+E, LFTS
INR
Glucose
Iron studies
NI liver screen
HIV
Autoimmue
Caeruloplasmin

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3
Q

What Ix would you want for hepatomegaly?

(not bloods)

A

USS
ascitic tap
biospy
CT/MRI
Fibroscan

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4
Q

Features to support malignancy Dx?

A

Cachexia
Lymphadenopathy

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5
Q

Examination findings to suggest NASH?

A

Xanthelasma
Finger prick marks

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6
Q

Features to suggest malignant cause of hepatomegaly?

A

Nodular lower edge
Cachexia
Lymphadenopathy

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7
Q

Most useful markers of hepatic function in cirrhosis

A

Albumin
Clotting

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8
Q

AST/ALT in ALD

A

AST:ALT ratio of >2:1

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9
Q

AST/ALT in ischaemic hepatitis

A

AST:ALT ratio of >50

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10
Q

What investigations do you want in ascitic fluid

A

Corrected neutrophils
Gram stain
ZN stain
Amylase/lipase
Cytology
Albumin
Glucose

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11
Q

Whats the use of an ascitic lipase/amylase?

A

High suggests pancreatic ascites from a ductal leak

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12
Q

Whats the use of a ascitic albumin?

A

High serum:ascites albumin gradient >1.1 suggests portal hypertension
Low gradient suggests cancer, TB, pancreatitis

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13
Q

Whats the use of an ascitic glucose?

A

Low suggests infection or malignancy

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14
Q

How would you manage ALD

A

Alcohol cessation
Chlordiazepoxide/pabrinex
Nutrition
OGD ?varices (only band if hx of haemorrhage)

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15
Q

What Ix would you want to assess pancreatic function?

A

Faecal elastase
Serum albumin
Vit D
Magnesium

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16
Q

How would you manage (chronic) pancreatitis?

A

Creon
PPI

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17
Q

What ascitic fluid result indicates SBP?

A

Neutrophils >250

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18
Q

What are you looking for in an OGD to Ix cirrhosis?

A

Varices
Portal hypertensive gastropathy
GAVE

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19
Q

What ascites result shows cirrhosis?

A

SAAG (serum ascites albumin gradient) over 1.1

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20
Q

What are causes of a high SAAG?

A

Cirrhosis
Budd Chiari
Nephrotic syndrome
Meigs syndrome

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21
Q

What are causes of a low SAAG?

A

TB
Malignancy
Pancreatitis

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22
Q

How do you do a liver biopsy if someone has ascites?

A

Transjugular

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23
Q

Causes of ascites: Vascular

A

Portal hypertension
Budd Chiari
CCF
Constrictive pericarditis

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24
Q

Causes of ascites: Albumin

A

Protein losing enteropathy
Nephrotic syndrome

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25
Causes of ascites: Peritoneal disease
Peritonitis Meigs syndrome Malignancy
26
Causes of ascites: Other
Pancreatic leak Chylous ascites peritoneal dialysis Advanced hypothyroidism
27
End of bed signs of liver disease
Jaundice Pigmentation Malnourishment
28
Hand signs of liver disease
Dupetryns Palmar erythema Leukonychia Asterixis
29
Eye signs of liver disease
Corneal arcus Xanthelasma Anaemia Jaundice
30
How is hereditary haemochromatosis inherited?
Autosomal recessive HFE gene on chromosome 6 Variable penetrance/phenotype
31
Presentation of Heriditary Haemochromatosis
Screening from 1st degree relative Asymptomatic high ferritin Arthalgia, lethargy Sex dysfunction (pituitary/testicular deposition) Diabetes (thirst, polyuria) Cardiomyopathy Bronze skin
32
Describe screening for Haemochromatosis
1st degree relatives Women ferritin \>200 trans sat \>40% Men ferritin \>300 and 50% Genotyping HFE
33
Further Ix for sequelae Hereditary Haemochromatosis
**HbA1c** Cirrhosis - **USS liver** **_AFP - Hepatocellular carcinoma_** **Echo** - cardiomyopathy +- Liver **biopsy** can assess disease severity but not always necessary
34
Tx of Hereditary Haemochromatosis
Venesect weekly ish until transferrin sat is \<50% (ferritin 20-30),then maintenance
35
Features of arthopathy ax with Hereditary Haemochromatosis
MCP Squaring of joints Chondrocalcinosis (differentiates from OA) Can also cause calcium pyrophosphate deposition
36
Further Bedside Ix for Herediatory Haemochromatosis examination
BM Urine - sugar ECG - AF/arrhythmias
37
Imaging for Hereditary Haemochromatosis
USS abdo Echo X ray hands
38
Monitoring for Hereditary Haemochromatosis (if cirrhosis)
AFP and USS liver every 6 months
39
Lifestyle advice for Hereditary Haemochromatosis
Don't drink - much worse liver disease
40
How is hereditary spherocytosis inherited?
Autosomal dominant Defect on one of five different genes that code proteins in RBC (usually chromosome 8)
41
How does hereditary spherocytosis typically present?
Anaemia Jaundice Splenomegaly Screening 1st degree relatives Neonatal jaundice
42
What are the complications associated with hereditary spherocytosis?
Aplastic crises due to infection Anaemia (tx with serial transfusion) Gallstones/cholecystectomy
43
Bloods to diagnose Hereditary Spherocytosis?
* *FBC** - reticulocyte count, **_Mean Corpuscular Haemoglobin MCH_** * *Blood smear** - spherocytes, haemolysis * *Haemolysis screen** - LDH, haptoglobin, split billirubin * *Coombs test** (EMA binding) or if not available **osmotic fragilty test**
44
What treatments are available for hereditary spherocytosis?
Folic acid Serial transfusions for anaemia Mod/severe can need splenectomy Vaccines (meningococcal, pneumo, flu) Prophylactic ABx
45
What is the mechanism of haemolysis in spherocytosis?
RBCs are sphere shaped rather than biconcave, then undergo haemolysis in the spleen
46
Triggers of worse anaemia in Hereditary Spherocytosis
Infection Infectious mononucleosis Pregnancy
47
Clinical signs of Hereditary Spherocytosis
Reduced pallor Jaundice Leg ulcers Tenderness in RUQ (gallstones)
48
What are the top 3 differentials for isolated splenomegaly?
CML Myelofibrosis Malaria
49
Bloods results in Hereditary Spherocytosis
High - LDH, unconjugated billirubin, reticulocytes Low/absent haptoglobin
50
J shape scar Renal transplant
51
Nephrectomy scar
52
Peritoneal dialysis
53
What do you need to comment on if you find a AV fistula
Recent needling If no needling and euvolaemic, can say that transplant is likely to be functioning
54
55
What follow up Ix would you want for IBD?
Stool sample FBC - WCC, anaemia Inflammatory markers Kidney - dehydration, electrolyte imbalance AXR Baseline LFTs
56
Management of acute IBD flare?
I’d start this patient on:  Intravenous steroids  Intravenous fluid  Electrolyte replacement,  I’d consider intravenous antibiotics (if I felt there was an infective element).
57
Indications for surgical referral IBD?
I would consider surgical referral if there was: o Any dilatation in her abdominal X-ray. o If there is any fistulating/abscesses o Or obstructive disease which was refractory to full medical management
58
On-going management of IBD flare?
long term **tapering** course of steroids. o add **steroid sparing** agent e.g Azathioprine. o **gastro ref (IBD nurse** specialist follow up). o **dietician** after 10 years **regular scopes**?pre malignant changes
59
What is coeliac disease?
autoimmune condition hypersensitivity to gluten Resulting in villous atrophy and malabsorption.
60
How would you Ix coeliac?
: • baseline blood tests • full blood count (looking for any signs of anaemia with ferritin, B12 and folate) * baseline kidney function. * liver function tests. * tissue transglutamase (with immunoglobulins as well). o I would also refer the patient for an upper GI endoscopy with biopsy
61
How would you manage coeliac?
dietician avoid gluten. correct nutritional deficiencies, consider repeat biopsy in 6-months’ time to confirm villous regeneration.
62
Tx for dermatits herpetiformis
No gluten Dapsone
63
Score for cirrhosis
Child Pugh A/B/C based on billirubin/albumin/INR/ascites/encephalopathy
64
Splenomegaly + lymphadenopathy
Haematological/infection
65
Splenomegaly + signs of chronic liver disease
Cirrhosis with portal hypertension
66
Splenomegaly + murmur, splinter haemorrhages
IE
67
Splenomegaly + signs of rheumatoid
Feltys syndrome
68
Indications for splenectomy
Rupture ITP Hereditary Spherocytosis
69
Causes of enlarged kidneys
PKD RCC Simple cysts Hydronephrosis Tuberous sclerosis/amyloidosis (bilateral)
70
4 signs of decompensated liver disease
Bruising Jaundice Ascites Encephalopathy
71
Types of renal transplant
Live donor - relative/altruistic Cadaveric
72
Live vs Cadaveric donor
Live - less handling time, less ischaemic time
73
How do you manage pancreatic pseudocyst
USS guided rain with axios stent, 6 weeks after presntation
74
Clinical features of pancreatic exocrine insufficency
* Steatorrhea * Weight loss * Vit D deficiency * Hypomagnesaemia * Low faecal elastase (in moderate/severe insuffiency)
75
How can you tell ileostomy vs colostomy
Ileostomy is liquid stool
76
Stoma RIF spouted Semi liquid faeces
Ileostomy
77
Indications for emergency surgery in IBD
Toxic megacolon Haemorrhage Perforation
78
Possible surgeries for UC
Subtotal colectomy with end ileostomy **End ileostomy with mucous fistula** (2 stomas, avoid leakage from rectosigmoid stump) **Protcolectomy and end ileostomy** **Proctocolectomy with an ileo anal pouch** reconstruction (maintains intestinal continuity, removes need for stoma, option for surgical reconstruction)

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