Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

PACES > Abdominal Station > Flashcards

Abdominal Station Flashcards

(66 cards)

Start Studying
1
Q

Differential Diagnosis for CLD

A
  • Alcoholic liver disease
  • Hepatitis B/C – tattoos, track marks
  • Autoimmune – vitiligo, thyroidectomy scar,
    Primary biliary cirrhosis – middle aged female, xanthelasma, excoriation marks, easy bruising, hepatosplenomegaly
    Autoimmune hepatitis
    Primary Sclerosing cholangitis
    Sarcoidosis
  • Drugs: Methotrexate, Amiodarone, Isoniazid, Antibiotics
  • Metabolic: NASH- xanthelasma, finger prick
  • Congestions: CCF, Budd Chiari
  • Hereditary – Hereditary haemochromatosis, Alpha-1 antitrypsin deficiency, Wilsons
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Features of decompensated CLD

A

Jaundice, Ascites, Encephalopathy

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

Signs of CLD

A

Palmar erythema, Dupytrenes contracture, Leukonychia, Spider naevia, Gynacomastia, Reduced axillary hair, Testicular atrophy, Caput medusa, Splenomegaly, Easy bleeding, Scratching, Jaundice

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

Features to suggest Wilsons disease

A

Kayser-Fleishcer rings,
Tremor
Chorea
Jaundice

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

Investigations for CLD

A

Urine Dip

Bloods - FBC, U&Es, LFTs, Clotting, CPR, Glucose, Gamma GT

Hep B, Hep C, EBV, CMV

Ferritin

Autoantibodies – ANA, anti-Mitrochondrial, anti-LKM, Anti-Smoothmusclr

Serum caeruloplasmin/Copper/24hr urinary copper

Alpha-1-antitrypsin

AFP

Abdo USS/Firbroscan, Ascitic tap

Liver biopsy

MRCP/ERCP

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

Management of CLD

A

Alcohol abstinence
Vitamint & thiamine replacement
Dietician
Salt restriction
Avoid hepatotoxic medication
Regular laxatives - air 3 soft stools/day

Carvedilol of variceas

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

Management of Ascites

A

Spironolatone - aim 1kg/weight loss/day
Add in furosemide if needed

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

SAAG >11g/L

A

Liver disorders,
Cardiac
Budd-Chiari, Porta vein thrombosis, Myoxeodema

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

SAAG < 11g/L

A

Hypoalbuminaemia - nephrotic, severe malnutrition
Malignancy - Peritoneal caricnoma
Infection
Pancreatitis, bowel obstruction

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

Scoring system used for prognosis in CLD & composition of each

A
  • Child-Pugh = albumin, bilirubin, PT, encephalopathy, ascites –> predicts survival
    - Score >7 = decompensated
  • MELD = bilirubin, creatinine and INR to predict survival
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Indication for liver transplant

A

Cirrhosis
Acute hepatic failure - viral or paracetamol OD
Hepatic malignancy

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

Pre liver transplant work up

A

Full liver screen
Up to date bloods
Viral serology
G&S
Tissue typing
ECG
CXR
Echo
PFTs
Cervical smear
Dental check up

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

Scoring system used to indicate need for transplant

A

UKLED (UK end-stage liver disease) score >49 or <49 + drug resistant and TIPS resistant ascites
(Na, Creatinine, Bilirubin, INR)

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

Scoring system used in acute liver disease

A

Maddrey score = prognosis >50% @ 5 years

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

Scoring system used in acute liver failure

A

Kings criteria (low pH <7.25, raised PT >100 or INR >6.5, raised Cr >300, anuria, Grade 3+ encephalopathy)

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

What are common precipitant of decompensated liver disease?

A

Infection, Increased alcohol intake, GI Bleed, Underlying malignancy, Constipation, Dehydration or increased salt intake, Hepatotoxic mediation

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

What are the complications of CLD?

A

Portal hypertension and varicese  GI haemorrhage, AScited, Juandice, Encephalopathy, SPB, Hepatorenal syndrome, Hepatopulmonary syndrome, HCC

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

What are the commonest causes of palmar erythema?

A

Chronic liver disease, Rheumatoid arthritis, Thyrotoxicosis, Pregnancy, Polycythaemia

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

What are the abdominal causes of finger clubbing?

A

IBD, Cirrhosis, Coeliac disease, HCC

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

How do you diagnose SPB?

A

Ascitic tap –> Neutrophils >250 per ml

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

Commonest cause of SPB?

A

E.coli

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

What features in an individual with chronic liver disease would warrant consideration of transplantation?

A

Progressive jaundice, Diuretic resistant ascites, HCC

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

Causes of splenomegaly

A

Haemolytic –> Lymphoma, Myelodysplastic syndromes (CML & Myelofirbosis), Haemolytic anaemia, Polycythaemia rubra vera
Pressure –> Portal hypertension secondary to liver disease or splenic vein thrombosis
Infection –> Malaria, Viscera leishmaniasis, EBV, Bacterial endocarditis
Infiltration –> Gauchers, Amyloidosis, Sarcoidosis,
Thyrotoxicosis

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

Post splenectomy complications

A

Increased risk from encapsulated organisms (S.Pneumonia, H Influenza), Thrombocytosis, Howell jolly bodies on smear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
IBD Signs
* Young, Pale, Cachectic * TPN line may be visible * Clubbing * Erythema nodosum, Pyoderma Gangrenosum (around stoma site) * Abdo – Scars, RIF Mass, Stoma (contents, surround skin), * Immunosuppression side effects signs * Aphthous ulcers, Enteropathic arthropathy, Conjunctivitis/episcleritis/anterior uveitis
26
Extraintestinal complications
Arthropathy, Eye Involvement, Anaemia, Aphthous Ulcers, Skins changes, Primary sclerosing cholangitis (UC), Cholangiocarcinoma, Renal stones
27
Crohns management - induce remission
Inducing remission = Steroids * 2nd line = 5-ASA drugs eg mesalazine * Add on drugs = azathioprine/mercaptopurine (check TPMT activity first to assess for risk of toxicity) or methotrexate * Alternative = elemental diet * Infliximab in refractory disease  if severe disease e.g intra-abdominal abscess * Metronidazole for peri-anal disease
28
Crohn's maintenance
* 1st line = azathioprine or mercaptopurine * 2nd line = methotrexate
29
UC induce remission
mild-to-moderate ulcerative colitis * topical (rectal) aminosalicylate eg mesalazine for 4 weeks * no benefit (or if disease extends beyond descending colon) --> add oral aminosalicylate * no remission --> add topical or oral corticosteroid Severe colitis * IV steroids eg 100mg hydrocortisone QDS o IV ciclosporin if steroids are contraindicated * no improvement after 72 hours --> add IV ciclosporin to IV corticosteroids o at this point if >8 stools per day or CRP >45  surgical review (85% need colectomy) * Pain worsens suddenly despite treatment  CT abdomen ?perforation * Severe IBD flare is a prothrombotic state – requires prophylactic LMWH
30
UC maintain remission
* topical (rectal) aminosalicylate +/- oral aminosalicylate eg mesalazine * In patients taking mesalazine, check U+E before starting, at 3 months, then annually, and also FBC (as 5-ASAs can cause interstitial nephritis and agranulocytosis) Following a severe relapse or >=2 exacerbations in the past year * oral azathioprine or oral mercaptopurine
31
What are side effects of steroids?
Weight gain, Acne, Fluid retention, Sleep disturbance, Alteration of mood, Hypoglycaemia, Dyspepsia Osteoporosis, Myopathy, Infections, Cataracts
32
What test is performed before administering thiopurines?
TPMT activity test or genotype to identify those at risk of leukopaenia.
33
Poor Prognostic factors in Crohns?
Onset <40, Female, Perianal, Fistulating, Stricturing, perforating disease, Steroids required at first flare, Upper GI lesions
34
What investigations are require prior to starting immunotherapy?
Check Heb B, Immunity to Varicella Zoster, Screen for latent TB, Consider outstanding live vaccinations
35
What is the scoring tool used for IBD Severity?
Truelove & Witt’s scoring
36
Causes of ESRD and features seen
* Diabetes --> Finger prick marks, Insulin injection sites (lipatrophy & lipohypertrophy) * Hypertension * Autosomal dominant polycystic kidney disease  Balotable flank masses, Nephrectomy scar * SLE --> reducible arthropathy of hands (Jaccouds), photosensitivity, scarring alopecia, * Alports syndrome --> Hearing aids * Tuberous sclerosis --> Subungal fibromas, adenoma sebaceum, shagreen patches, ash lead macules * MPGN type 2: Lipdystrophy
37
Hoe might patients with ADPKD present?
Hypertension Signs & Symptoms of Renal Failure Proteinura Haematuria Extra-renal manifestations - liver cysts, pancreas, spleen or thyroid Loin pain, calculi or infection
38
Inheritance of PKD?
* It is an autosomal dominant condition. * There are two main genetic mutations that are associated. * Around 80% of patients have a mutational chromosome 16. * About 15% having a mutational chromosome 4. * There remainder of patients have no detectable genetic abnormality.
39
differences between each inherited type?
* Polycystic kidney disease type 2 is associated with a mutated chromosome 4. * Tends to be less severe with later onset. * Fewer cysts. * Later progression to renal failure.
40
How would you treat someone with PKD?
* Good control of blood pressure ideally with ACE inhibitors is very important. * There should also be aggressive control of hyperlipidaemia. * CKD is a major risk factor for ischaemic heart disease. * Patients should be on a high-fluid low-salt diet. * CKD stage 1–3 of the disease vasopressin receptor antagonist, eg tolvaptan, may be of use. * Later in the disease, the patient may require renal replacement therapy and/or transplant.
41
Complications of Tacrolimus
* Diabetogenic, Tremor
42
Ciclosporin – Calcineurin inhibition, decreases IL2 Side effects
* Nephrotoxic, Hepatic dysfunction, Gum hypertrophy & hypetrichosis, HTN, High lipids & glucose
43
Azathioprine side effects
* BM suppression (Test for TMPT), Hepatotoxic
44
Mycophenolate side effects
* Pale palmar creases, conjunctival pallor, oral ulcers
45
Nephritic glomerulonephritis features
* Haematuria, Proteinuira, HTN, Clots,
46
Causes of Nephritic glomerulonephritis
Post Infective (IgA Nephropathy), Rapidly progressive (Vasculitis), Alports, Post streptococcal (anti-streptolysin O titre), HSP
47
Nephrotic features
Proteinuria >35g/day, PCR >3.5 + Hypoalbuminaemia <30 + Oedema
48
Causes of nephrotic
Diabetes, Minimal change, Membranous, Autoimmune – RA, PAN, SLE, Infection - Heb B/C, HIV, Amyloidosis, Malignancy, Pregnancy,
49
What genetic abnormalities are seen in PKD?
Mutation in PKD-1 on chromosome 16 (ESRF at younger age), smaller number have mutation in PKD-2 on chromosome 4 (later onset, less cysts, less progressive)
50
What are the extrarenal features?
Hepatic cysts, Intracranial berry aneurysms, Mitral valve prolapse
51
Which renal cystic conditions are at high risk of neoplastic transformation?
Von hippel Lindau & Tuberous sclerosis
52
What is Von Hipple-Lindau
AD inherited disorder causing multiple tumours – benign and malignant in CNS & Viscera * Retinal haeangioblastomas, CNS haemangioblastomas, RCC, Renal cysts, Phaeochromocytomas (Type 2 > Type1)
53
What is Tuberous Sclerosis
Multisystem Disorder. Formation of hamartomas in many organs – brain, skin & kidneys. Kidneys --> PKD, Angiomyolipoma, Simple cysts, RCC.
54
How would you test to see if the graft is working?
Examination – tender, bruit, uraemic encephalopathy Urine Output Urinary protein on dip/collection Renal function on bloods Consider biopsy under specialist opinion
55
What are the complications of renal transplant?
Graft rejection Disease recurrent Renal artery stenosis Opportunistic infection Immunosuppressant Side Effects IHD HTN Skin cancer & Lymphoma
56
Causes of gum hypertrophy?
Scurvy, Leukaemia, Ciclosporin, Phenytoin, Nifedipine
57
Indications for urgent dialysis
* Uraemia – pericarditis/peluritis * Encephalopathy/Neuropathy * Resistant fluid overload * Resistant electrolyte abnormalities * Resistant malignant hypertension
58
Complications of dialysis: Haemodialysis
* Dialysis Washout  Volume losss, Dizziness, Light headed, Chest pain, Nausea * Bleeding * Infection * Fistula thrombosis/Infection * Amyloidosis – accumulation of B2-microglobulin
59
Complications of dialysis: Peritoneal
* Infection – Peritonitis * Diabetes * Local complications – hernia, catheter site infections
60
Complications of chronic renal failure
* CVS – HTN, Volume overload, Increased IHD, Decreased Hb * Metabolic – uraemia, Hyperkalaemia, Metabolic acidosis * Bones – Hyperphosphataemia, Hypocalcaemia (lack of Vit D hydroxylation), Hypercalcaemia – secondary  tertiary hyperparathyroidism, Renal osteodystrophy
61
When start work up for transplant:
As they approach end stage CKD (eGFR <15), before dialysis
62
Contraindication to transplant
* Predicted survival <5 years * Predicted risk of graft loss >50% @ 1yr * Unable to comply with immunosuppressant therapy * Risk of life-threatening complications of immunosuppression (chronic viral illness, malignancy)
63
Workup for transplant:
* Renal screen – assess cause * Blood tests, Virology, G&S * ECG, Echo, PFT, CXR * Up to date cervical smear * Dental check up
64
Superiority of AV fistula over alternative HD access
Lower risk of infection Lower risk of thrombosis Greater longevity & long term accessibility Greater blood flow volume Shorter duration of dialysis Most cost effectice
65
Advice for pts with new AV fistula
Protect against direct trauma in first few days Avoid overuse of arm Do not drive or lift heavy objects for first 2 weks Carry out strengthening exercises (squeeze rubber ball) 2-3 times hourly in first few weeks
66

PACES (1 decks)

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