Abdominal Flashcards
(32 cards)
What are the causes of end-stage renal failure?
Common causes:
- Diabetes mellitus
- Glomerulonephritis
- ADPKD
- Hypertension
Rarer causes:
- Reflux nephropathy
- Other hereditary renal diseases (e.g. Alport’s)
- Renovascular disease
- Chronic obstruction/interstitial nephritis
What are the barriers to renal transplantation (including contraindications)?
Barriers:
- Donor matching
- Organ availability
- Availability of support
Contraindications:
- Active/recent malignancy
- Active deep-seated infection
- Active vasculitis
- Severe obesity
What are the commonly requested lab tests for an ascitic tap?
- Cell count (neutrophil >250 mm^3 suggests SBP)
- Gram stain
- Albumin (SAAG >1.1g/dL suggests systemic cause of ascites such as heart failure and chronic liver disease)
- Amylase/lypase (elvated levels suggests pancreatitis)
What are the indications for nephrectomy in ADPKD?
- Recurrent UTIs
- Chronic pain
- RCC
- Debulking for symtpom control or in preparation for transplantation
What are the causes of mild-moderate splenomegaly?
Infiltrative:
- Lympho-/myeloproliferative diseases
- Lymphomas
- Amyloidosis
- Sarcoidosis
- Gaucher’s disease
- Thyrotoxicosis
Increased function:
Red blood cell removal
- Hereditary spherocytosis
- Thalassaemias
- Sickle cell anaemia
Immune hyperplasia
- Chronic malaria
- Kala-azar (visceral leishmaniasis)
- Glandular fever
- Infective hepatitis
- Subacute bacterial endocarditis
- Brucellosis
Disordered immunoregulation
- RA + Felty’s syndrome
- SLE
- Sarcoidosis
Abnormal blood flow
- Portal hypertension
- Hepatic/portal vein thrombosis
What are the causes of massive splenomegaly?
- CML
- Myelofibrosis
- Gaucher’s disease
- Chronic malaria
- Kala-azar (visceral leishmaniasis)
What are the irreversible signs of chronic liver disease even following liver transplantation?
- Gynaecomastia
- Dupuytren’s contractures
- Spenomegaly
What are the indications for liver transplantation?
Main indications:
- Liver cirrhosis due to chronic liver disease
- HCC
- Acute liver failure
Other variant syndromes:
- Diuretic-resistant ascites
- Chronic hepatic encephalopathy
- Intractable pruritus
- Hepatopulmonary syndrome
- Polycystic liver disease
- Recurrent cholangitis
What are the main contraindications to liver transplantation?
- Drug abuse
- Ongoing alcohol abuse (especially if indication for transplantaiton is alcohol-related liver disease)
- Significant medical comorbidities
- Significant psychiatric comorbidities
- Age (not absolute contraindication but survivial rates for transplantation >65yrs old is significantly lower)
- Active malignancy
- History of malignancy (not absolute but recurrence rates will need to be taken into account)
What are the main complications associated with liver transplantation?
Graft:
- Acute/chronic rejection
- Recurrence of primary liver disease
Immunosuppression:
- Side-effects of immunosuppressant medications
- Infections (bacterial, viral, fungal)
- Malignancy (especially skin malignancies)
- Metabolic syndrome (hypertension, diabetes, dyslipidaemia)
Biliary:
- Biliary leak
- Biliary strictures
What is the King’s College criteria for emergency liver transplantation in acute paracetamol overndose?
pH <7.3
or in 24hrs period:
- INR >6 &
- Creat >300mmol/L &
- Grade III - IV encephalopathy
What are the causes of ascites?
Vasular:
- Portal hypertension
- Budd-Chiari
- Congestive heart failure
- Constrictive pericarditis
Hypoalbuminaemia:
- Nephrotic syndrome
- Protein-losing enteropathy
Peritoneal disease:
- Meig’s syndrome
- Infectious peritonitis (TB, fungal)
- Malignancy
Other:
- Pancreatitis
- Chyle leak
- Peritoneal dialysis
- Hypothyroidism
What are the causes of high SAAG (>1.1 g/L) ascites?
- Portal hypertension
- Congestive heart failure
- Nephrotic syndrome
- Budd-Chairi
- Meig’s syndrome
What are the causes of low SAAG (<1.1 g/L) ascites?
- Malignancy
- Infectious peritonitis
- Pancreatitis
What is the threshold for screening individuals for hereditary haemochromatosis?
- 1st degree relative with diagnosis of haemochromatosis
- All adult patients of Northern European ancestry with unexplained raised serum ferritin
(> 300 µ/l men; > 200 µ/l women) and a random transferrin saturation (> 50% men; >
40% women) and normal full blood count
What are the benefits of SPK in patients with type 1 diabetes?
- Reduced mortality
- Improved quality of life without need for insulin administration or frequent BM monitoring
- Improved glycaemic control
- Prevention/partial reversal of long-term complications of diabetes (inlcuding cardiovascular, nephropathy and neuropathy; evidence unclear for retinopathy)
What are the causes of gynaecomastia?
- Physiological (puberty)
- Chronic liver disease
- Testicular atrophy
- Klinefelter’s syndrome
- Drugs (e.g. spironolactone)
What are the complications of long-term alcohol misuse?
Cardiovascular:
- Cardiomyopathy
- Hypertension
Liver/GI:
- Alcohol-related liver disease
- Pancreatitis
- Peptic ulcer disease
- UGI cancers
Neurological:
- Cerebellar atrophy
- Polyneuropathy
- Wernicke-Korsakoff’s syndrome
What are the genetic causes of pancreatitis?
- Cystic fibrosis
- PRSS1
- SPINK1
How can a patient be assessed for pancreatic exocrine insufficiency?
Clinically:
- Steatorrhoea
- Weight loss
Laboratory:
- FBC (anaemia)
- Albumin (low)
- Vitamin D (low)
- Magnesium (low)
- Faecal elastase (low in moderate - severe insufficiency))
What are the main differences between Crohn’s disease and ulcerative colitis?
Crohn’s disease:
- Can affect any part of the GI tract
- Anal fissures are possible complications
- Inflammation affecting all layers of the intestines, making perforation possible
- Increased numbers of goblet cells
- Granuloma formation
Ulcerative colitis:
- Usually involves the rectum with variable length of colon but doesn’t spread beyond the ileocaecal valve
- No anal involvement
- Inflammation does not spread beyond submucosa so perforation unlikely
- Goblets cells depleted
- Crypt abscess formation
- Granulomas uncommon
What are the renal complications associated with ADPKD?
- Hypertension
- Recurrent UTIs
- Cyst rupture
- Cyst haemorrhage - can cause haematuria
- Cyst infection
- Renal stones
- Mass effect caused by increased kidney size from polycystic kidneys causing abdominal pain, GORD and early satiety
- ESRF
Which autoantibodies are implicated in liver disease?
- PBC: Anti-mitochondrial (M2 subtype)
- PSC: ANA, anti-smooth muscle
- AIH: Anti-smooth muscle, anti-LKM1
What are the indications for splenectomy?
- Rupture following trauma
- Treatment of haematological disease (e.g. ITP, hereditary spherocytosis)
