Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

PACES Revision Cards > Abdominal Flashcards > Flashcards

Abdominal Flashcards

(92 cards)

Start Studying
1
Q

Autosomal Dominant Conditions

A

APKD type 1 (chromo 16) and type 2 (chromo 4)
Hereditary spherocytosis
HHT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Autosomal Recessive Conditions

A

Haemochromatosis (chromo 6)
Wilson’s disease (chromo 13)
Alpha 1 antitrypsin (chromo 14)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can you differentiate the spleen from a kidney on palpation?

A

1) Dull to percussion

2) Not ballotable

3) Palpable splenic notch

4) Cannot get above splenic mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Outline some causes of Spider Naevi?

A

= vascular lesion in distribution of SVC

> 5 = pathological

1) Normal in childhood

2) Pregnancy

3) Oestrogen

4) Chronic liver disease

5) Thyrotoxicosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Outline causes of Acanthosis Nigricans

A

Insulin-resistant diabetes mellitus
Paraneoplastic
Hypo/hyperthyroidism
Acromegaly
Cushing’s disease
Obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Outline causes of gynaecomastia

A

Idiopathic

Chronic liver disease
Chronic kidney disease
Thyrotoxicosis
Congenital e.g. Klinefelter’s

Drugs e.g.
- Haloperidol
- Spironolactone
- Omeprazole
- Alcohol
- Ketoconazole
- Digoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Outline causes of Hepatomegaly

A

Cs & Is of Hepatomegaly

C - Cirrhosis
C - Carcinoma (HCC)
C - CCF

I - Infectious e.g. Hepatitis, EBV, CMV
I - Immune(Auto) e.g. PBC, PSC
I - Infiltrative e.g. Amyloidosis
I - Iron (Haemochromatosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is pre-hepatic jaundice?

A

Jaundice = elevated serum bilirubin

Pre-hepatic = disruption in bilirubin pathway occurs prior to hepatic bilirubin conjugation
Increased RBC haemolysis = increase in levels of UNCONJUGATED bilirubin

Causes:
- Haemolytic anaemias
- Gilbert’s (autosomal recessive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is post-hepatic jaundice?

A

Jaundice = elevated serum bilirubin

Post-hepatic = disruption in bilirubin pathway occurs after hepatic bilirubin conjugation, and results in reduced excretion of bilirubin from body

Blockage prevents excretion of CONJUGATED bilirubin

Causes:
- Gallstones
- Pancreatic cancer
- Cholangitis
- Cholangiocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which blood tests can you do to differentiate between types of jaundice?

A

Liver function tests (ALT>ALP indicates hepatic damage, raised yGT and ALP indicates post hepatic “cholestatic”)

Split bilirubin (conj & unconj bilirubin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Outline the blood tests involved in a liver screen

A

AUTOIMMUNE
- ANA, anti-mitochondrial antibody, anti-smooth muscle antibody, liver-kidney microsomal antibody
- Anti-TTG

INFECTIOUS
- Hep B surface antigen, Hep C antibody
- Hep B core antibody
- CMV/EBV (if acute)

Immunoglobulins

METABOLIC
- HbA1c
- Ferritin & iron studies
- Caeruloplasmin

Alpha feto-protein

Paracetamol (if acute)

?alpha 1 AT level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Outline the pathophysiology of Liver Cirrhosis

A

1) Hepatocellular injury

2) Stimulates stellate cells to become myofibroblasts

3) Myofibroblasts secrete pro-inflammatory cytokines and produce collagen

4) = Tissue fibrosis

5) = Distorts hepatic architechture and vasculature

6) = Portal hypertension and only hepatocellular injury due to reduced perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the main causes of liver cirrhosis?

A

TOP 3
Alcohol
MASLD
Hepatitis C

Other important causes
- Autoimmune e.g. AIH, PBC
- PSC
- Haemochromatosis
- Wilson’s
- CF
- Alpha 1 AT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is decompensated CLD? How could this present?

A

= acute deterioration in liver function in patients with cirrhosis

Jaundice
Asterixis
Confusion
Ascites
Peripheral oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Outline some risk factors for developing decompensated liver disease

A

Alcohol
Infection
AKI/Dehydration
Constipation
Medications e.g. sedating agents
Thrombosis e.g. hepatic vein thrombus
Fluid overload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Child Pugh grading?

A

Severity of cirrhosis score

A to C
- A = 100% 1 year survival
- C = 50% 1 year survival

5 components to score
1) Serum albumin
2) Ascites
3) Bilirubin
4) INR
5) Hepatic encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Outline how you would investigate for ?chronic liver disease

A

Full history
Medication history
Alcohol history

Routine bloods, including FBC, U&Es, coagulation and LFTs
Non-invasive liver screen blood tests
- See other flashcard

USS Liver

?CTAP/MRCP (depends of type of jaundice)

FIB-4 score (predicts likelihood of advanced fibrosis)

Transient Elastography (fibroscan)

Liver biopsy?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Who are offered Transient Elastography in order to screen for liver cirrhosis?

A

Patients with Hepatitis C
Men who drink > 50 units of alcohol/week
Women who drink > 35 units of alcohol/week
Patients with known Alcoholic Liver Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which criteria can help you decide which patients with cirrhosis should have OGD surveillance for oesophageal varices?

A

Baveno Criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How often should patients with liver cirrhosis be offered HCC screening? What does this entail?

A

Liver USS every 6 months +/- aFP levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Outline the management of ascites

A

Reduce dietary intake of sodium

Aldosterone antagonist (spironolactone)

Monitor weight

Therapeutic abdominal paracentesis

Transjugular intrahepatic portosystemic shunts

?Prophylactic antibiotics e.g. ciprofloxacin
- If previous SBP or cirrhotic with ascitic protein < 15g/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Risk of TIPS procedure

A

Increased risk of hepatic encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What would be the main indication for performing a transjugular liver biopsy as opposed to percutaneous?

A

Ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How can you delineate between transudate and exudate causes of ascites?

A

Serum:Ascites Albumin Gradient

SAAG>11g/L = Transudate

SAAG< 11g/L = Exudate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Causes of Transudate Ascites
Cirrhosis with portal HTN CCF Nephrotic syndrome Budd-Chiari Portal Vein thrombosis Malabsorption Myxoedema (Failures and Thrombuses)
26
Causes of Exudate Ascites
Malignancy e.g. metastatic GI cancers, HCC, ovarian, peritoneal TB peritonitis Pancreatic ascites Meig's Syndrome = ovarian fibroma, pleural effusion & ascites Bowel Obstruction Serositis in CTD
27
What is hepatorenal syndrome?
Renal hypoperfusion and failure, secondary to severe liver disease Type 1 = Rapidly progressive, poor prognosis Type 2 = Slowly progressive
28
How would you manage a patient with hepatorenal syndrome?
MDT approach - liver and renal specialists Terlipressin (splanchnic vasoconstrictor) Cautious monitoring of fluid balance - + HAS 20% TIPSS
29
Grading of Hepatic Encephalopathy
West Craven Criteria 0 = clinically normal 1 = mild confusion, irritability, short attention span, disordered sleep 2 = drowsy, disorientated, inappropriate 3 = somnolent but rousable to voice, v confused, amnesia 4 = comatose
30
Alcoholic Hepatitis
= inflammatory condition related to ongoing alcohol intake Severe Alcoholic Hepatitis = 30-50% 4 week mortality Transaminases usually >500 AST:ALT > 2 MANAGEMENT - Alcohol abstinence + withdrawal support - MDT approach (nutrition, ASNs) - Maddrey's discrimnant function can help determine if will benefit from steroids (>32) MELD score (Model for End Stage LD) - prognostic predictor
31
Autoimmune Hepatitis
3 main types 1) Type 1 = positive ANA and anti-smooth muscle antibodies - Adults & children 2) Type 2 = Anti-liver/kidney microsomal type 1 antibodies (LKM1) - Mainly children 3) Type 3 = Soluble liver-kidney antigen - Middle aged adults Usually young women, with associated autoimmune conditions e.g. coeliac Raised IgG!!!! Autoantibodies & liver biopsy MANAGEMENT - Steroids or steroid-sparing immunosuppression e.g. azathioprine - Liver transplant
32
Primary Biliary Cholangitis
Autoimmune condition - destruction of small intrahepatic ducts F:M = 9:1, middle aged women Anti-mitochondrial antibodies & IgM Associations = RA, Sjogren's, Systemic sclerosis, coeliac Classically asymptomatic with isolated raised ALP Itch/fatigue/RUQ pain/jaundice
33
Management of Primary Biliary Cholangitis
MDT approach Alcohol abstinence Pruitus = cholestyramine Vitamins ADEK (d2 reduced fat soluble vitamin absorption) Ursodeoxycholic acid (reduces cholestasis and can improve prognosis) Liver transplant (esp if bili > 100)
34
Possible complications of PBC
Liver cirrhosis HCC (20x increased risk) Osteoporosis/osteomalacia Vitamin ADEK deficiency If have liver transplant, there is a risk of recurrence!
35
Primary Sclerosing Cholangitis
= Inflammatory condition of intra and extrahepatic ducts = progressive scarring and obstruction Associations = UC (80% of PSC pts have UC), Crohn's, HIV Male > Female pANCA positive ANA and anti-smooth muscle antibodies MCRP --> ERCP (beaded appearance) ?Liver biopsy
36
Management of Primary Sclerosing Cholangitis
MDT approach Alcohol abstinence Vitamins (ADEK) Ursodeoxycholic acid ?Liver transplant SCREENING - If have IBD = annual colonoscopies - Screening for cholangiocarcinoma
37
Possible complications of Primary Sclerosing Cholangitis
Chronic liver disease & cirrhosis Cholangiocarcinoma (10% increased risk!) Increased risk of colorectal cancer
38
Haemochromatosis
Autosomal recessive disorder of iron metabolism HFE gene on chromosome 6 (variable penetrance) Fatigue, arthralgia, sexual dysfunction (anterior pituitary function impaired in 2/3) Multisystem - Bronze skin - Hypopituitarism = hypothyroid, sexual dysfunction, amenorrhoea - Dilated cardiomyopathy - T1DM - CLD/cirrhosis - Arthritis, pseudogout +++ increased risk of HCC
39
How would you investigate for haemochromatosis?
Full history & examination etc Ferritin & Iron studies - Raised ferritin - Raised transferrin saturation (>55% in men, > 50% in women) - Raised iron levels - Low TIBC HbA1c Liver biopsy (Perl's Stain) Joint xrays (chondrocalcinosis) Echocardiogram Genetic testing (HFE gene most common) and offer family screening
40
Management of Haemochromatosis
MDT approach - liver, endocrine, cardiology Alcohol abstinence (increases iron accumulation) Genetic counselling Venesection (weekly to start) - according to transferrin saturation & ferritin levels Desferrioxamine = Iron chelator ?Liver transplant MONITORING - Regular iron studies - 6 monthly USS & aFP - Monitor HbA1c
41
Wilson's Disease
Autosomal recessive condition resulting in excess copper deposition in tissues ATP7B gene on chromosome 13 Onset = 10-25 years old Multisystem - Asterixis, chorea, dementia/neuropsych - Kayser-Fleischer rings - Haemolytic anaemia - Hepatitis --> cirrhosis - Renal tubular acidosis Low levels of caeruloplasmin (= copper transport in serum) = less copper in serum, more deposited in tissues Increased urinary copper excretion Rx = pencillamine (chelator)
42
Alpha 1 Antitrypsin Deficiency
Autosomal Recessive SERPINA1 gene on chromo 14 COPD like respiratory disease (young pts with no smoking history) Liver cirrhosis MANAGEMENT - Alcohol abstinence - Stop smoking - MDT approach - ?recombinant alpha 1 AT
43
Hepatocellular Carcinoma
3rd most common cancer worldwide CAUSES - Chronic Hepatitis B - Chronic Hepatitis C - Alcohol - Haemochromatosis - PBC SCREENING = 6 monthly USS +/- aFP Offered for high risk groups e.g. - Cirrhosis secondary to Hep B/C - Cirrhosis secondary to haemochromatosis - Male pt with alcoholic cirrhosis
44
Which cancer commonly metastasize to the liver?
Colorectal (adenocarcinoma) Lung Breast Pancreatic Gastric Oesophageal
45
Most common conditions for Liver Transplant
Commonest in UK = ALD ALD Paracetamol OD MASLD Autoimmune disease e.g. PBC Haemochromatosis HCC
46
Criteria for Liver Transplant (Paracetamol)
= King's Criteria ABG pH < 7.3 Encephalopathy grade 3-4 PT > 100 seconds
47
Criteria for Liver Transplant (Non paracetamol)
All 3 of : 1) PT>100 seconds 2) Grade 3-4 encephalopathy 3) Cr >300 OR any 3 of ... - PT > 50 seconds - Jaundice/hepatic encephalopathy for >7 days - >10 or <40 years old - Bilirubin >300 - Unfavorable aetiology
48
Complications of Liver Transplant
Surgical Complications - Bleeding - Post op infection - Biliary leak - Hepatic/portal vein thrombosis Transplant Dysfunction - Rejection/graft failure - Recurrence of previous disease Complications of immunosuppression - Infections - Malignancy - CVD
49
Complications of Immunosuppression
Infections - Bacterial, viral, fungal Malignancy, esp skin Nephrotoxicity HTN Increased CVD risk
50
Causes of Pancreatitis
*GET SMASHED* Gallstones Ethanol Trauma Steroids Mumps Autoimmune Smoking Hypercalcaemia/Hypertriglyceridaemia ERCP Drugs e.g. azathioprine *Genetic causes* - Cystic fibrosis
51
Complications of Pancreatitis
ACUTE - Multisystem SIRs - Resp failure/ARDS CHRONIC - Pain - T3DM - Portal/splenic vein thrombosis - Biliary/duodenal obstruction - Malignancy - Pseudocysts
52
Management of Chronic Pancreatitis
CONSERVATIVE - Alcohol abstinence - Stop smoking - Nutrition input MEDICAL - Creon if evidence of malabsorption (faecal elastase) + PPI - Analgesia, pain team SURGICAL - Endoscopic USS drainage of pseudocysts or AXIOS stent 6 week after initial presentation
53
Indication for Combined Pancreas Kidney Transplant
T1DM +/- ESRF
54
Pros & Cons of Combined Pancreas Kidney Transplant
PROs + Potentially curative of T1DM + Free from haemodialysis and insulin therapy + Reduced risk of vascular complications of diabetes (unclear if affects retinopathy yet) CONS - Lifelong immunosuppression (with risks of toxicity/infection/cancer) - Risk of rejection/failure (5-7%) - Risk of graft thrombosis
55
Why are transplanted pancreas now attached to the duodenum?
Previously, transplant pancreas was anastomosed to bladder - Could monitor pancreatic activity/risk of pancreatitis through urinary amylase However - risk of urological complications and reflux pancreatitis! Now, most transplanted pancreas are attached to the duodenum
56
Complications of Chronic Kidney Disease
1) HTN & IHD 2) Anaemia (due to reduced EPO production) 3) Bone Mineral Disease - May require parathyroidectomy for secondary hyperparathyroidism 4) Fluid retention 5) Uraemic complications e.g. pericarditis, encephalopathy 6) Calciphylaxis- painful necrotic lesions
57
Causes of Enlarged Kidneys
Autosomal Dominant PKD Hydronephrosis Renal tumour(s) Congenital renal anomalies e.g. horseshoe kidney Amyloidosis
58
Commonest causes of ESRF
Diabetes nephropathy Hypertensive nephropathy ADPKD Chronic Glomerulonephritis Obstructive uropathy
59
Indications for Renal Replacement Therapy
RRT should be considered once eGFR <15 1) Hyperkalaemia (if refractory to Rx) 2) Metabolic acidosis (if refractory to Rx) 3) Complications of uraemia e.g. pericarditis 4) Severe pulmonary oedema/intractable fluid overload
60
Contraindications to Living Donor Kidney Transplant
Uncontrolled HTN Active Malignancy Chronic infection Bilateral renal artery atherosclerosis Sickle Cell Disease
61
Why are Kidney Transplants placed in the pelvis?
Good blood supply Sufficient space Proximity to bladder for ureteric anastomosis Easy access for biopsies/nephrostomies
62
Complications of AV Fistulae
Infection - of AVF site - Endocarditis Thrombosis Stenosis - Often present with acute limb pain Steal Syndrome - Reduction/reversal of arterial blood flow distal to AVF = hand ischaemia
63
Complications of Haemodialysis
DURING USE - Hypotension - Disequilibrium (blood urea reduced too rapidly = cerebral oedema) - First-Use Syndrome = reaction to dialyser membrane (mild to anaphylactic) - Haemolysis LONG TERM - CVD (20X more likely to die from CVD) - Malnutrition - Cardiomyopathy Burden on quality of life - hospital appointments, restricted travel
64
Contraindications to Peritoneal Dialysis
IBD End-stage liver disease with ascites (SBP!) Unrepaired abdominal hernias Previous complex abdo surgeries Polycystic Kidney Disease
65
Complications of Peritoneal Dialysis
Peritonitis - PD fluid WBC >100 - Can be recurrent/refractory - Staph aureus most common cause Hyperglycaemia (glucose used as dialysate) Catheter blockage Fluid retention Constipation Hernias Sclerosing Encapsulating Peritonitis --> risk of bowel obstruction
66
Outline example regime of immunosuppression for renal transplant
INITIAL - Ciclosporin/tacrolimus with monoclonal antibody MAINTENANCE - Ciclosporin/tacrolimus with mycophenolate mofetil + regular steroids if >1 steroid responsive acute rejection episode
67
Side Effects of Calcineurin Inhibitors
= Ciclosporin and Tacrolimus Nephrotoxicity (C>T) Tremor Hyperkalaemia HTN & hyperlipidaemia (CVD!!) CICLOSPORIN - Gingival hyperplasia - Hypertrichosis TACROLIMUS - PRES - New Onset Diabetes After Transplant (NODAT) - Alopecia
68
Examples of renal disease which can recur post renal transplant
IgA Nephropathy Membranoproliferative GN - lipodystrophy Focal Segmental Glomerulonephritis Membranous GN Amyloidosis
69
Opportunistic Infections in Renal Transplant pts
CMV EBV Pneumocystis jiroveic BK virus - usually dormant in renal tract - causes ureteric stenosis and interstitial nephritis JC virus - PML!
70
Autosomal Dominant Polycystic Kidney Disease
Most common cause of inherited kidney disease Autosomal dominant 2 main types - Type 1 = PKD1 - polycystin 1 on chromo 16 - Type 2 = PKD 2 - polycystin 2 on chromo 4 EXTRA-RENAL FEATURES - Berry aneurysms (SAH) - Mitral valve prolapse/regurg - Aortic root dilatation / dissection - Liver cysts (70%)!!! - Diverticulitis --> perforation - Abdominal herniae
71
Management of ADPKD
BP control - ACEIs Tolvaptan = vasopressin receptor antagonist - Can slow rate of renal function decline & cyst progression - Offered if CKD 2 or 3 or rapidly progressive ?Nephrectomy Plan for RRT (monitor renal function)
72
Indications for Nephrectomy in patients with ADPKD
1) Make room for kidney transplant 2) Chronic pain 3) Chronic renal cyst infections 4) Progression to RCC (rare)
73
Alport's Syndrome
X-linked dominant condition (COL45 gene) - abnormal type IV collagen More severe in males Progressive renal failure Bilateral sensorineural deafness Lenticonus Retinitis pigmentosa Rx = ACEIs and renal transplant HOWEVER - can develop anti-GBM antibodies to transplanted kidney = Goodpasture's syndrome
74
Ulcerative Colitis
Limited to colon Continuous but superficial mucosal inflammation Crypt abscesses on histology Smoking improves symptoms/stopping smoking can unmask condition 80% of PSC pts have UC Colectomy = curative
75
Crohn's Disease
Mouth to anus. Perianal disease particularly key feature of crohn's disease Skip lesions with transmural inflammation Granulomas on histology Smoking exacerbates symptoms
76
Diagnostic criteria for Acute Colitis
= Truelove & Witts Criteria MILD <4 stools/day No systemic features Normal ESR MODERATE >4 stools/day Minimal systemic features SEVERE >6 stools/day with blood Systemic features e.g. fever, tachycardia ESR >30
77
Management of Acute Colitis
IV fluids IV steroids (100mg hydrocortisone QDS) VTE prophylaxis Avoid antispasmodics/antimotility drugs Discuss with gastro +/- surgical team eCXR and AXR important but if acutely unwell, consider CT AP
78
Indications for urgent surgical intervention in patients with severe UC
Toxic megacolon (caecum>9cm, colon > 5.5cm) Still having >8 stools/day or CRP>45 after 3 days of IV steroids Failure to respond to treatment after 10 days
79
Management of UC (mild-moderate)
Inducing Remission - Topical +/- oral aminosalicylate - PO corticosteroid if not responding Maintaining Remission - Topical and/or oral aminosalicylate - Azathioprine if 1) Severe relapse 2) >2 exacs in past year
80
Factors which increase UC patient's risk of colorectal cancer
Have had UC > 10 years Pancolitis Onset before age of 15 Unremitting Poor compliance to treatment
81
Inducing and maintaining remission in Crohn's Disease
Inducing Remission - Aminosalicylates and/or steroids - Isolated perianal disease = metronidazole - Refractory/fistulating/severe = Infliximab Maintaining Remission - STOP SMOKING! - 1st line = Azathioprine (test TMPT level first - risk of bone marrow toxicity) - 2nd line = MTX
82
Hereditary Haemorrhagic Telangiectasia
A.k.a Osler-Weber-Rendu syndrome Autosomal dominant Diagnostic Criteria (4) - 2 criteria = possible - 3 criteria = definite 1) Spontaneous/Recurrent Epistaxis 2) Telangiectasias - Typical sites = lips, oral cavity, fingers & nose 3) Visceral lesions e.g. AVMS 4) FHx (1st degree relative)
83
Peutz Jeghers Syndrome
= numerous benign hamartomas in GI tract and hyperpigmented macules over hands/lips/feet Autosomal dominant Increased risk of malignancy - Breast - Ovarian - Cervical - Pancreas - Testicular 50% mortality from GI tract cancer by age of 50 Rx = Pan-intestinal colonoscopy every 2-3 years
84
Causes of Splenomegaly
1) INFILTRATIVE - MPD, lymphoma - Sarcoidosis, amyloidosis - Gaucher type 1 2) INCREASE IN FUNCTION = removal of defective of RBCs - Hereditary Spherocytosis - Sickle Cell disease - Thalassaemia OR = immune system disordered/overactive - Malaria - EBV, CMV - Visceral leishmaniasis - Endocarditis - Felty's syndrome - SLE 3) PORTAL HYPERTENSION
85
Causes of MASSIVE Splenomegaly
cML Myelofibrosis Malaria Visceral leishManiasis
86
Outline the investigations you would request for work up of a patient with splenomegaly
Abdominal exam +/- rheum/thyroid exam Bloods - FBC, U&Es, LFTs - TFTs - Blood film - Haemolysis screen e.g. LDH, haptoglobin, reticulocytes - HIV screen Thin and thick films x 3 if suspect malaria USS abdomen CT TAP (?malignancy) Bone marrow aspirate& trephine
87
Hereditary Spherocytosis
Most common hereditary haemolytic anaemia in pts of Northern European descent Autosomal dominant - Defect in RBC cytoskeleton = spherical RBCs = destroyed by spleen sooner Failure to thrive Jaundice (prehepatic) Splenomegaly Aplastic Crisis (parvovirus infection)
88
Investigations for Herediary Spherocytosis
Bloods - FBC, B12, folate, MCV, MCHC - Blood film (spherocytes!) - If diagnosis unclear = Cryohaemolysis test & EMA binding (Used to do osmotic fragility test) USS abdomen (size of spleen)
89
Management of Hereditary Spherocytosis
MDT approach ?Genetic counselling Folate replacement Splenectomy - Indicated if: 1) Recurrent anaemia 2) Massive splenomegaly If get splenectomy = Need vaccinations against encapsulated organisms (pneum & meningo) prior to surgery and then prophy abx after
90
Chronic Myeloid Leukaemia
CML = 15% of all leukaemias = uncontrolled myeloid proliferation Philadelphia chromosome in 95% = translocation between 9 & 22 (BCR-ABL gene) Anaemia B symptoms - fever, weight loss, night sweats Massive splenomegaly Rx = Imatinib (inhibits BCR-ABL tyrosine kinase) ?Bone marrow transplant
91
Chronic Lymphoblastic Leukaemia
Commonest haematological malignancy in adults Accumulation of mature B cells "MATURE B cells in MATURE adults" B symptoms Enlarged rubbery non-tender LNs Hepato/splenomegaly RX = monitoring of FBC if asymptomatic/no BM failure/splenomegaly <10cm otherwise = FCR (fludarabine/cyclophosphamide/rituximab)
92
Lymphoma
Hodgkins (presence of Reed Sternburg Cells) or Non Hodgkins Painless lymphadenopathy - Alcohol induced pain in NHL B symptoms Hepato-splenomegaly Ann-Arbor Staging Risk of - Bone marrow failure (anaemia/ neutropaenia/thrombocytopaenia) - AML transformation - Compressive effects e.g. SVCO

PACES Revision Cards (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions