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Flashcards in Abdominal Deck (21):
0

CLD complications

Portal hypertension (ascites, hypersplenism, varices)
Synthetic dysfunction (albumin, clotting)
Hepatic encephalopathy
Hepatorenal
Hepatopulomary
HCC

1

Causes of CLD

Commonest = alcohol + viral
Toxins: alcohol, drugs (amiodarone, methotrexate)
Viral: hepB, hepC, CMV, EBV
Metabolic: non-alcoholic steatohepatitis, haemochromatosis, wilsons, alpha-1-antitrip
Autoimmune: AIH, PBC, PSC
Neoplasm: HCC, mets
Vasc: Budd-Chiari, RHF

2

Hepatosplenomegaly causes

Portal HTN
CML
Non-Hodgkins lymphoma
Infective endocarditis
Myelofibrosis
Infiltration (amyloidosis)
Granulomatous disease (TB, sarcoid, wegeners)
Other infectious (malaria, kala-azar, schisto)

3

Hepatomegaly causes

Cirrhosis
CCF
Neoplastic (Mets and primary)
Infective: acute viral, liver abscess
Polycystic disease
Tricuspid regurg
Budd-Chiari
Haemochromatosis
Infiltration: amyloidosis, sarcoidosis

4

Splenomegaly causes

Cirrhosis with portal hypertension
Myeloproliferative: CML, myelofibrosis
Lymphoma
Infections: endocarditis, EBV, CMV, malaria, kala-azar
SLE, RA, scleroderma, sarcoidosis
Haemolytic anaemias

5

Causes of asterixis

Hepatic encephalopathy
Uraemia
Hypercapnea
Electrolytes: hypoglycaemia, hypokalaemia, hypoMg
Drug intoxication: barbiturates, phenytoin, alcoholism

6

Precipitants of hepatic encephalopathy

Increased nitrogen: constipation, GI bleed, blood transfusion, infection, hypokalaemia
Decreased toxin clearance: dehydration, hypotension, anaemia, portosystemic shunts
Altered neurotransmission: benzos, psychoactive drugs
Hepatocellular damage: continued alcohol use, HCC

7

Examination findings of encephalopathy

Confusion
Hyper-reflexia
Rigidity
Asterixis
Myoclonus
Hippus (rhythmic dilation/constriction of pupil)

8

PBC associated AI conditions

RA, thyroid, Sjögrens, scleroderma, SLE, coeliac

9

PBC treatment

Ursodeoxycholic acid or cholestyramine.
Liver transplant

10

What does haemochromatosis affect?

Liver
Joints
Heart
Skin
Endocrine

11

Wilsons diagnostic tests

Low serum copper and caeruloplasmin
High 24-hour urinary copper
Gold standard is liver biopsy
ATP7B gene analysis

13

Wilson's disease management

D-penicillamine and trientine promote excretion
Penicillium in not used for neuropsych symptoms, use zinc salts instead and for presymptomatic patients

14

Causes of ascities

Cirrhosis
CCF/RHF
Intra-abdominal malignancy
Hypoalbuminaemia
Uncommon (nephrotic syn, TB, chylous)

15

Causes of portal hypertension

Pre-hepatic: thrombosis
Hepatic: cirrhosis
Post-hepatic: Cardiac (RHF, TR), Budd-Chiari

16

Ascites treatment

Treat underlying condition, daily weights, fluid + salt restrict, diruetics (spiro).
Therapeutic paracentesis (give HAS)
If diuretic-resistant - shunting (TIPS, peritoneovenous) or transplant

17

Jaundice causes

Commonest = Haemolysis, CLD, gallstones
Pre-hepatic: haemolysis (AIHA, HS, SCD, G6PD, malaria)
Hepatic: CLD, Hepatitis (EtOH, viral), Drugs (para, statins, anti-TB), Congential, AIH, Ca
Post-hepatic: Gallstones, Panc Ca, PBC, PSC, cholestasis (OCP, augmentin)

18

Differential for Mercedes Benz Scar

Hepatobiliary surgery
- Liver transplant
- Segmental resection
- Whipples’: pancreaticoduodenectomy

19

Differential for bilateral renal enlargement

APKD
Bilateral hydronephrosis
Amyloidosis
Tuberous sclerosis
Von-Hippel-Lindae disease

20

APKD associations

Liver, splenic, pancreatic cysts
Heart: mitral valve prolapse, AR
Intracranial aneurysms
Colonic diverticula, abdo hernias

21

Common causes of CKD

DM
GN e.g. IgA nephropathy
Reflux nephropathy
Obstructive nephropathy
Renovascular disease
Hypertension
Polycystic kidney disease