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PACES final > Abdominal station > Flashcards

Abdominal station Flashcards

1
Q

single palpable kidney causes

A

PKD
Hydronephrosis
renal cyst
renal carcinoma
hypertrophy pf solitary functioning kidney

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2
Q

signs of PKD

A

resonant ballotable masses, oedema for renal failure, AV fistula, blood pressure and urine dip for renal failure

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3
Q

PKD associated with

A

berry aneurysms, hepatic cysts, mitral valve prolapse

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4
Q

PKD facts

A

Autosomal dominant
1 in 1000
HTN, UTI’s, cyst haemorrhage, haematuria
End stage renal failure at 40-60yo

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5
Q

DDx for bilateral kidney masses

A

ADPCKD, bilateral renal cysts, bilateral renal cell carcinoma, bilateral hydronephrosis, amyloidosis, tuberous sclerosis

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6
Q

Abdo causes of clubbing

A

Hepatic cirrhosis
Coeliac disease
Ulcerative colitis
Crohn’s disease
GI lymphoma

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7
Q

What is IBS?

A

Recurrent abdo pain for 1d/week for 3 months with association with defecation, change in frequency of stool, change in form of stool

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8
Q

IBS treatment

A

Conservative = advice, FODMAP, CBT
Medical = bulk forming laxatives, analgesia = mebeverine, loperamide for diarrhoea

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9
Q

Coeliac disease…

A

Villous atrophy, from gliadin + gluten. Associated with other autoimmune conditions
Extra intestinal = dermatitis herpetiformis, anaemia, hyposplenism, osteomalacia, T cell lymphoma

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10
Q

Coeliac disease investigations

A

Ensure eating gluten for 6w prior to testing
1st line = IgA TTG levels + Serum IgA levels
+ve = endoscopy + duodenal biopsy = increased intraepithelial lymphocytes, villous atropy, crypt hyperplasia
2nd line = IgA EMA

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11
Q

UC treatment acute severe disease

A

Signs = >6 stools, frank blood, fever, HR >90, anaemia, ESR>90
admit + IV hydrocortisone
If no improvement at 72 hours = IV ciclosporin + biologics then surgical input

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12
Q

UC non-severe treatment

A

Pancolitis = Topical + oral aminosalicylate if no improvement at 4 weeks = oral corticosteroids
Proctitis, proctosigmoiditis, L sided colitis = topical aminosalicylate if no improvement at 4w = oral corticosteroids

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13
Q

Toxic megacolon

A

UC or C.diff infection
3-6-9 rule
IV hydrocortisone + infliximab

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14
Q

Renal transplant signs

A

AV fistula. If no needle marks, no thrill, thrombosed = non-functioning
Glucose monitoring marks on finger
Rutherford Morrison scar, flank scar

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15
Q

Renal failure signs

A

cachexia, old AV fistula scars, peritoneal catheters, pulmonary and peripheral oedema, pallor

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16
Q

Indications for renal transplant

A
  • Diabetic nephropathy
  • Polycystic kidney disease
  • Glomerulonephritis
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17
Q

complications of renal transplant

A
  • Rejection
  • Cushing syndrome
  • Skin malignancy (BCC + SCC)
  • Ciclosporin = gym hypertrophy
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18
Q

signs of splenomegaly

A

Dull mass, moves with respiration and non-ballotable
Beyond midline = massive splenomegaly
Unable to palpate liver edge = tense ascites

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19
Q

causes of splenomegaly

A

Haematological = CML, myelofibrosis, spherocytosis
Infective = malaria, EBV
Other = portal hypertension, amyloidosis, sarcoidosis

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20
Q

causes of hepatomegaly

A

Haem = CML
Infective = malaria, EBV
Other = amyloidosis, sarcoidosis

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21
Q

indications for splenectomy

A

Traumatic rupture, idiopathic thrombocytopaenia, spherocytosis

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22
Q

splenectomy prophylaxis

A

Pneumococcus, meningococcus, Haem Influenza B, Penicillin V

23
Q

Signs of decompensated liver disease

A

Worsening jaundice, ascites, encephalopathy, coagulopathy, hypoglycaemia, varices, splenomegaly

24
Q

signs of portal HTN

A

visible veins
splenomegaly
ascites

25
Q

Signs of chronic stable liver disease

A

palmar erythema, spider naevi, gynaecomastia, dupytrens contracture, testicular atrophy

26
Q

liver disease complications

A

Variceal bleed = terlipressin + banding
Ascites = spironolactone, ascitic drain, TIPS
Encep = lactulose
SBP = broad spec Abx
Hepatorenal syndrome = terlipressin, albumin, TIPS

27
Q

AST/ALT ratio 2:1

A

alcohol related

28
Q

chronic liver disease signs

A

General = cachexia, jaundice, excoriations, bruising, lack of axillary hair
Hands = dupuytren’s, palmer erythema, clubbing
Face = icteric sclerae, parotid swelling
Abdomen = spider naevi, caput medusae, gynaecomastia, ascites, splenomegaly

29
Q

Specific signs in chronic liver disease

A

Parotid swelling = alcohol
Needle marks = hepatitis C
Bronze complexion = haemochromatosis
Obesity + diabetes = NAFLD
Xanthelasma = cholestatic disease

30
Q

chronic liver disease presentation

A

“Today I examined this gentleman’s abdominal system. On general inspection he is cachectic, jaundiced and has a distended abdomen. He has digital clubbing and multiple spider naevi. There was no hepatic asterixis present. His abdomen was soft and non tender. Shifting dullness was present. On palpation there was no organomegaly. These signs are consistent with decompensated chronic liver disease with ascites but not encephalopathy. I would like to take a full history and perform blood tests to determine the cause.”

31
Q

causes of chronic liver disease

A

Infective = hep B , hep C (serology)
Toxic = alcohol
Metabolic = NAFLD, haemochromatosis, A1AD, wilson’s disease (ferritin, transferrin, caeruloplasmin)
Autoimmune = autoimmune hepatitis, PSC, PBC

32
Q

complications of cirrhosis

A
  1. Portal hypertension - variceal haemorrhages/spontaneous bacterial peritonitis, thrombocytopaenia
  2. Hepatocellular failure - encephalopathy, HCC, hypoalbuminemia, coagulopathy
33
Q

IBD signs

A

young, pallor, ileostomy, oral ulcerations, pyoderma gangrenosum, clubbing, medications e.g. azathioprine or mesalazine

34
Q

signs of complications of IBD

A

Scars from Hickman lines for Parenteral nutrition, cushingoid, gum hypertrophy, jaundice, urosdeoxycholic acid, hepatosplenomegaly

35
Q

identifying stomas

A

Ileostomy = usually right sided, spouted, looser contents
Colostomy = left sided, flush to skin, thicker contents
Urostomy = urine coloured

36
Q

IBD presentation

A

Today I examined this gentleman’s abdominal system. On inspection he was pale and slim. There was no digital clubbing. He had a stoma in his right iliac fossa and a midline laparotomy scar. His abdomen was soft and non tender. There were no hernias or fistulae. These signs would point to a diagnosis of Crohn’s disease with a defunctioning ileostomy, or ulcerative colitis with an end ileostomy, or a panproctolectomy for familial adenosis polyposis. I would like to take a full history and examine him for any perianal disease

37
Q

Extra-intestinal manifestations of IBD

A

Eyes = uveitis, episcleritis, scleritis
Skin = pyoderma gangrenosum, erythema nodosum
Other = clubbing, oligoarthritis, anaemia

38
Q

complications of crohns

A

strictures, obstruction, fistulae

39
Q

complications of UC

A

toxic megacolon, colonic carcinoma, PSC

40
Q

Indications for stoma in crohns

A

failure of medical management, obstruction, fistulae

41
Q

Indications for stoma in UC

A

failure of medical management, toxic megacolon or malignancy

42
Q

What stoma for crohns

A

de-functioning loop ileostomy

43
Q

what stoma for UC

A

end ileostomy for a panproctocolectomy or a diversion ilesotomy with a ileal rectal pouch formation
if emergency = hartmanns = colostomy

44
Q
A

Erythema nodosum SORE SHINS
Step, IBD, sarcoid, drugs

45
Q

Normal abdominal exam presentation

A

Today I performed an abdominal examination of X year old Y.
On general inspection the patient was normal body habitus, was comfortable at rest and did not have any catheters or drains.
On closer inspection of the hands and arms, the patient did not exhibit any stigmata of abdominal disease such as palmar erythema, clubbing or signs of IVDU.
Extremities were warm with normal capillary refill. There was no asterixis. Pulse was regular at Z.
On closer inspection of face and chest, no anaemia, scars or spider nevi were identified.
JVP was non raised and the abdomen did not show any hernias or scars.
Abdomen was soft non tender and with no organomegaly.
Abdominal aortic pulse was present and non-expansile.
Bowel sounds were present and normal, and there were not bruits audible.
In conclusion this was a normal abdominal examination. To complete my examination, I would like to take full history, examine the external genitalia and the hernial orifices.
I would like to take a full set of observations, perform a DRE as well as capillary glucose and urinary dipstick I would like to order bloods, including FBC, U&Es and LFTs for baseline, and order an abdominal CT if indicated.

46
Q

how do you examine a stoma?

A

Inspection
1. Location
2. Spouted vs. flush
3. Pink/healthy
4. Bag content
5. Number of lumens

Palpation
1. Para-stomal hernia

Completion
1. Examination of perineum
2. Removal of bag and digital examination of stoma

47
Q

criteria for AP resection?

A

Ca <4-5cm from anal verge

48
Q

what possible procedures cause a midline laparotomy scar?

A
  • AAA repair (emergency or elective)
  • Hartmann’s
  • Trauma
  • Colon Ca removal
  • Perforated ulcer (duodenal) repair/resection
  • (Conversion from laparoscopic procedure to open)
49
Q

early complications from stoma formation

A
  • Pain
  • Infection
  • Haemorrhage
  • High output – electrolyte & fluid balance
50
Q

late complications from stoma formation

A

Late
* Prolapse
* Skin reactions
* Stenosis/stricture
* Psychological impact

51
Q

causes of chronic renal disease

A

Diabetes mellitus 34%
Glomerulonephritis 21%
Hypertension 12%

52
Q

hemodialysis complications

A

dialysis washout
bacteremia
bleeding
associated amyloidosis

53
Q

peritoneal dialysis complications

A

bacterial peritonitis
failure
DM
hernia
infection

PACES final (12 decks)

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