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PACES - Final Week Revision > Abdominal > Flashcards

Abdominal Flashcards

(66 cards)

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1
Q

Primary biliary cholangitis examination

A

Middle aged woman
Xanthelasma
Excoriation marks
Easy bruising
Hepatosplenomegaly

High ALP
Anti-mitochondrial antibody
Ursodeoxycholic acid to slow progression or liver transplant

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2
Q

Autoimmune hepatitis examination

A

Hepatomegaly, Jaundice
Vitiligo
Thyroidectomy scar
Steroid side-effects

ANA, AMA, anti-LKM antibodies
Steroids, immunosuppressants or liver transplant

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3
Q

Cause of Wilson’s disease?

A

Autosomal recessive, ATP7B gene

Reduced excretion of copper into the bile and therefore accumulation into organs such as brain, heart and liver

Causes low caeruloplasmin levels

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4
Q

Indications for urgent dialysis

A

AEIOU:
Acidosis <7.1
Electrolytes (refractory hyperkalaemia)
Ingestions (lithium, salicylates, alcohols)
Overload (congestive cardiac failure)
Uraemia (pericarditis or encephalopathy)

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5
Q

Complications of an AV fistula?

A

Infection
Thrombosis
Stenosis
Steal syndrome

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6
Q

Vascular access for RRT?

A

AV fistula
AV graft
Tunnelled venous catheter
Non-tunnelled venous catheter

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7
Q

ALWAYS present renal features of

A

Uraemia
Fluid overload
Features of renal replacement therapy

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8
Q

Causes of Nephrotic syndrome

A

FSGS
Minimal change disease
Membranous nephropathy
Membranoproliferative nephropathy

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9
Q

Symptoms of Cushing syndrome

A

Bruising, hypertension
Stretch marks, weight gain
Carpal tunnel
Proximal myopathy
Hirsutism, periods/erections

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10
Q

Causes of Cushing syndrome

A

ACTH-dependent:
- Pituitary microadenoma (MEN1)
- ectopic secretion by lung tumour
ACTH-independent:
- Adrenal adenoma or hyperplasia
- Iatrogenic from oral prednisolone

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11
Q

Investigation for Cushing syndrome

A

Confirming test:
Overnight dex suppression test or 24h urinary cortisol

Localising test: high dose dex suppression test
If ACTH and cortisol high —> CT thorax
If ACTH high and cortisol low —> MRI pituitary
If ACTH low —> CT adrenals

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12
Q

Causes of high serum-ascites albumin gradient >1.1g/l (transudate)

A

Liver cirrhosis
Congestive cardiac failure
Nephrotic syndrome
Meig’s syndrome

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13
Q

Causes of low serum-ascites albumin gradient <11.1g/l (exudate)

A

Hepatocellular carcinoma
Pancreatitis
Tuberculosis

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14
Q

Appendicectomy scar

A

McBurney’s incision

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15
Q

Liver transplant scar

A

Mercedes Benz or modified rooftop incision

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16
Q

Kidney transplant scar

A

Rutherford-Morrison incision

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17
Q

Management of Polycystic kidney disease

A

BP and lipid control
ACE inhibitor
Low salt diet
Active monitoring for kidney failure

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18
Q

Extra renal manifestations of Polycystic kidney disease

A

Hypertension
Cysts in liver/pancreas
Berry intracranial aneurysm
Mitral valve prolapse

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19
Q

Blood liver screen

A

ANA
AMA - PBC
ASMA - autoimmune hepatitis
LKM antibody - autoimmune / drug-induced hepatitis

Electrophoresis
Caeruloplasmin
Ferritin/transferrin - Haemochromatosis
AFP tumour marker

US abdomen and portal vein
Ascitic taped

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20
Q

Treatment for PBC

A

Ursodeoxycholic acid
Statins for high lipids
Oral vitamins
Calcium and biphosphonates for osteoporosis
Liver transplant

Cholestyramine or naltrexone for pruritus relief

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21
Q

Liver patient - what do you present

A
  • Peripheral signs:
    Dupuytren’s & palmar erythema
    Spider naevi, gynaecomastia
    Liver size
    Nutritional status
  • Signs of portal hypertension: splénomégalique, caput medusa
  • Evidence of décompensation: Astérixis, ascites, jaundice
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22
Q

Causes of Jaundice

A

Pre-hepatic:
- congenital red cell pathology (SCD, G6PD deficiency)
- autoimmune haemolytic anaemia
- malaria
Hepatic:
- Gilbert syndrome
- cirrhosis, cancer
- viral hepatitis
- drugs
Post-hepatic:
- biliary tree obstruction
- PBC
- PSC

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23
Q

King’s criteria for liver transplant in NON-paracetamol-induced liver failure

A

INR > 6.5
Or
Any three of the following 6:
- age >40
- not hepatitis related
- encephalopathy lasting over 7 days
- INR >3.5
- bilirubin >300

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24
Q

Symptoms of Uraemia

A

Fatigue, weight loss
Nausea, vomiting
Itching
Cognitive slowing, confusion
Frequent shallow breathing, metabolic acidosis

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25
Causes of CKD
Diabetes Hypertension Glomerulonephritis Polycystic kidney disease Alport syndrome
26
ADPKD mutations
ADPKD1 on chrom 16 ADPKD2 on chrom 4
27
Differentials for unilateral palpable kidney
ADPKD Renal cell carcinoma Obstructive uropathy
28
Differentials for bilateral palpable kidney
ADPKD Von Hippel-Lindau syndrome Tuberous sclerosis
29
Causes of chronic liver disease
Alcohol Non-alcoholic fatty liver disease Infectious: Viral hepatitis, Malaria, CMV, EBV Autoimmune: PBC, PSC Metabolic: Haemochromatosis, Wilson’s disease Cardiovascular: portal vein thrombus, congestive cardiac failure
30
Signs of décompensation liver disease
Asterixis Bruising Jaundice Distended abdomen (ascites) Evidence of portal hypertension (splenomegaly)
31
Score for severity of chronic liver disease
Child-Pugh score: Bilirubin Albumin INR Ascites Encephalopathy
32
Causes of hepatomegaly
Cancer Cirrhosis Cardiac failure Infection Immunological Infiltrative
33
Causes of Splenomegaly
Massive: CML, myelofibrosis, malaria, visceral leishmaniasis Moderate: CLL, portal hypertension, Gaucher disease, Felty’s, PRV
34
Causes of MASSIVE Splenomegaly
CML (Philadelphia chromosome) Myelofibrosis Malaria
35
Causes of ESRF
Hypertension Diabetes Glomerulonephritides (FSGS, minimal change, membranous glomerulonephropathy)
36
Causes of Adrenal insufficiency
Primary: - Addison’s disease - adrenal adenoma - TB Secondary: - exogenous steroids - pituitary adenoma
37
Symptoms of Addison’s disease
Fatigue Weight loss Postural BP Nausea/Vomiting, abdo pain, diarrhoea Hyperpigmentation, vitiligo
38
Investigations for adrenal insufficiency
- Bloods (normocytic anaemia, low Na, high K, abnormal TFTs) - 9am cortisol (<100 indicative of adrenal insufficiency, >400 suggests fine, otherwise borderline so order short synacthen test) - ACTH (high if primary, low if secondary) - Short synacthen test (if rise to >500 after 30 mins then suggestive) - low aldosterone, high renin
39
Management of adrenal crisis
Admission for: - IV fluids - hyperkalaemia management - IV hydrocortisone 100mg QDS - IV antibiotics if infection is the precipitant
40
Autoimmune syndromes of which Addison’s disease can be part of?
Autoimmune polyglandular syndrome types 1 and 2
41
Autoimmune polyglandular syndromes
- type 1: chronic candidaisis, hypoparathyroidism, Addison’s, T1DM, thyroid disease - type 2: Addison’s, T1DM, thyroid disease
42
Counselling patient on Addison’s disease
- sick day rules (double dose of oral steroids if infection, emergency hydrocortisone if vomiting) - if strenuous exercise then ensure team mate knows to administer emergency hydrocortisone
43
Tests to do on ascitic fluid
Microscopy, gram stain & culture Cytology & cell count Albumin, glucose, LDH, amylase
44
Polycystic kidney disease genes
PKD1 PKD2
45
Spleen exam
Can’t palpate above Medial notch
46
Kidney exam
Palpable upper border Ballotable Moves inferiority with respiration NO NOTCH
47
Management of Wilson’s disease
Low copper diet Chelating agents (penicillamine) Zinc supplements Complications: liver failure, HCC, CKD
48
Management of hereditary Haemochromatosis
Venesections Monitor diabetes and cardiomyopathy
49
Definition of Nephrotic syndrome
Proteinuria >3.5g/24h Low albumin High lipids Peripheral oedema
50
Management of nephrotic syndrome
Low sodium diet Fluid restriction BP control and reduce cardiovascular risk Anticoagulation due to risk of VTE
51
Complications of nephrotic syndrome
Increased risk of infection VTE CKD increased cardiovascular risk
52
Tumours in Von Hippep-Lindsay syndrome
Renal/Cerebellar/Spinal haemangioblastomas Renal cell carcinoma Phaechromocytoma Pancreatic cancer
53
Cause of abdominal pain in PKD?
Cyst rupture or haemorrhage Renal stones UTIs
54
Causes of papillary necrosis
Pyelonephritis Obstruction Sickle cell disease Tuberculosis Cirrhosis Aspirin nephropathy Renal vein thrombosis Diabetes
55
Examination findings for failed transplant
Fluid overload Hypertension Tenderness over graft Uraemic symptoms Recently used fistula/tunnelled line
56
Opportunistic infections in transplants
HSV (shingles) CMV pneumonitis or retinitis Pneumocystis jiroveci pneumonia
57
Malignancies after transplant
Skin SCC Lymphoma Post transplant lymphoproliferative disease
58
Management of ascites
Therapeutic paracentesis Salt restricted diet Fluid restriction Spironolactone Liver transplant vs TIPSS vs serial paracentesis
59
Management of varices haemorrhage
IV fluids IV terlipressin IV antibiotics Urgent OGD for banding
60
Extra-hepatic manifestations of Haemochromatosis
Skin hyperpigmentation Diabetes Cardiomyopathy —> ICD and CCF Arthritis Hypogonadism
61
Management of Haemochromatosis
Venesection once to twice a week Regular US liver and AFP level due to increased risk of HCC
62
Extra-hepatic manifestations of hepatitis B
Polyarteritis modo sa Glomerulonephritis with nephrotic syndrome Palpable purpura
63
Management of Hepatitis B
Entecavir, Tenofovir Alpha-interferon therapy
64
Extra-hepatic manifestations of hepatitis C (5)
Diabetes Peripheral neuropathy Glomerulonephritis Lymphoma Cryoglobulinaemia
65
Polycythaemia Rubra Vera management
Venesection to haematocrit <45% Hydroxycarbide
66
Complications of Polycythaemia Rubra Vera
Budd-Chiari syndrome Strokes Myelofibrosis Leukaemia

PACES - Final Week Revision (7 decks)

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