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YR6 Images + Instruments > Abdominal Vivas > Flashcards

Abdominal Vivas Flashcards

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1
Q

What causes ascites with a SAAG >11?

A

Liver: Cirrhosis, alcoholic hepatitis, acute liver failure, liver mets

Cardiac: Right HF, constrictive pericarditis

Budd-chiari syndrome, portal vein thrombosis

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2
Q

What is indicated by a high SAAG >11?

A

Transudate
Portal HTN

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3
Q

What causes ascites with a SAAG <11?

A

Hypoalbuminaemia: nephrotic syndrome
Malignancy: peritoneal carcinoma
Tuberculous peritonitis
Pancreatitis
Bowel obstruction

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4
Q

What is indicated by a low SAAG <11?

A

Ascitic fluid is an exudate

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5
Q

5 complications of ascites

A

SBP
Hepatorenal syndrome
Malnutrition
Pleural effusion
GI bleed

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6
Q

What is SBP? How is it diagnosed? What is the most common organism involved?

A

Bacterial infection of ascitic fluid
Paracentesis: neutrophils >250 cells/ul
E.coli

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7
Q

Management of SBP

A

IV Cefotaxime

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8
Q

SBP prophylaxis

A

Ciprofloxacin PO for those with cirrhosis + ascites with ascitic protein ,<15
or if have had an episode of SBP

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9
Q

Management of ascites

A

Reduce dietary sodium
Fluid restrict
Aldosterone antagonists: Spironolactone
Therapeutic abdominal paracentesis (requires albumin cover)
Transjugular intrahepatic portosystemic shunt (TIPS)

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10
Q

What is a transjugular intrahepatic portosystemic shunt?

A

Procedure creates internal ‘bypass’ between portal vein + hepatic vein

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11
Q

List 4 indications for a TIPS procedure?

A

Acute variceal bleeding where other interventions have failed
Recurrent variceal bleeding
Refractory ascites
Hepatorenal syndrome

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12
Q

What is hepatorenal syndrome?

A

‘Functional’ kidney impairment due to severe renal vasoconstriction in patients with cirrhosis
Reduction in renal blood flow + GFR

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13
Q

4 absolute CI to laparoscopic surgery

A

Haemodynamic instability/ shock
Raised ICP
Acute intestinal obstruction with dilated bowel loops (> 4 cm)
Uncorrected coagulopathy

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14
Q

Indications for laparoscopic surgery

A

Diagnostic: appendicitis, PID, endometriosis

Therapeutic: Appendicectomy, cholecystectomy, hernia repair, hysterectomy, fibroidectomy

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15
Q

4 Benefits of laparoscopy

A

Faster recovery time + shorter stay
Less pain
Less risk of infection
Smaller scars

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16
Q

5 Complications of laparoscopy

A

Risks of anaesthetic
Vasovagal bradycardia in response to abdominal distension
Extra-peritoneal gas insufflation: surgical emphysema
Injury to GIT
Injury to blood vessels e.g. common iliacs, deep inferior epigastric artery

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17
Q

Which patient should be assessed for renal transplant?

A

All with end stage renal failure (GFR <15) or CKD stage 4 with progressive disease (GFR 15-29)

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18
Q

List 5 absolute contraindications to renal transplant

A

Untreated malignancy
Active infection
Untreated HIV/ AIDS
Condition with life expectancy <2y
Malignant melanoma within past 5y

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19
Q

Renal transplant immunosuppression regime

A

Initial: ciclosporin/ tacrolimus with a monoclonal antibody (Basilximab)

Maintenance: ciclosporin/ tacrolimus with MMF or Sirolimus

Add steroids if >1 steroid responsive acute rejection episode

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20
Q

Graft survival for renal transplants

A

Cadaveric: 1y= 90%, 10y = 60%
Living-donor: 1y= 95%, 10y= 70%

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21
Q

5 post-op problems of renal transplant

A

ATN of graft
Vascular thrombosis
Ureteric leaks
UTI
Delayed graft function (need for dialysis within 1st week)

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22
Q

Describe hyper acute rejection of a renal transplant

A

Mins- hours
Due to pre-existing Abs to ABO/ HLA
Widespread thrombosis of graft vessels + ischaemia + necrosis
Graft MUST be removed

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23
Q

Describe acute graft failure

Study These Flashcards
A

<6 months
Due to mismatched HLA/ CMV
Asymptomatic rise in creatinine + proteinuria
May be reversible with CS + immunosuppression

24
Q

Describe chronic graft failure

Study These Flashcards
A

> 6 months
Ab + cell mediated mechanisms causing fibrosis of kidney
Recurrence of original disease

25
What do patients on long term immunosuppression for organ transplant require monitoring for?
CVS disease: tacrolimus + ciclosporin can cause HTN + hyperglycaemia. Tacrolimus can also cause hyperlipidaemia. Renal failure: due to nephrotoxic effects of tacrolimus + ciclosporin/ graft rejection/ recurrence of original disease Malignancy: educate on minimising sun exposure to reduce risk of squamous + basal cell carcinomas
26
RIF Mass ddx
Appendix: abscess, neoplasms Caecal carcinoma Ovarian tumour/ cyst Crohn’s disease Psoas abscess Iliac lymphadenopathy Transplanted/ ectopic kidney Ileocecal tuberculosis
27
LIF Mass ddx
Faeces (indentable) – loaded sigmoid Sigmoid or descending colon cancer Diverticular disease Ovarian tumour/ cyst Psoas abscess Crohn’s disease Transplanted pelvic kidney Iliac lymphadenopathy
28
Suprapubic mass ddx
Enlarged bladder Uterine mass e.g. fibroids Pregnant uterus Ovarian mass e.g. cyst
29
Inguinal mass ddx
Herniae (inguinal, femoral) Lymphadenopathy Vascular: aneurysm, pseudoaneurysm, hematoma Psoas abscess Ectopic or undescended testis Lipoma of the cord Hydrocoele of the cord
30
Left hypochondrium mass ddx
Splenomegaly Pancreatic CA Colon CA Kidney mass
31
Right hypochondrium mass ddx
Hepatomegaly Enlarged gallbladder: empyema, mucocoele, CBD obstruction (pancreatic CA) Kidney mass Colon CA
32
Epigastric mass ddx
Retroperitoneal lymphadenopathy (e.g. lymphoma, teratoma) AAA Gastric CA Pancreatic pseudocyst or tumour Transverse colon CA
33
What is this? What is it used for?
Tesio line Inserted into IJV (or can do subclavian) Emergency haemodialysis Haemodialysis where fistula unsuitable
34
3 types of renal replacement therapy
Haemodialysis Peritoneal dialysis Renal transplant
35
Describe haemodialysis
3x per week 3-5h At least 8w before commencement of Tx, patient must undergo surgery to create an arteriovenous fistula, which provides site for haemodialysis
36
Describe peritoneal dialysis
Dialysis solution injected into abdominal cavity through a permanent catheter. High dextrose conc. of solution draws waste products from blood into the abdominal cavity across the peritoneum. After several hours of dwell time, dialysis solution drained, removing waste products from the body, + exchanged for new dialysis solution
37
What are the 2 types of peritoneal dialysis?
Continuous ambulatory peritoneal dialysis (CAPD): each exchange 30-40 mins, each dwell time 4-8h. Patient may go about their normal activities with dialysis solution in their abdomen Automated peritoneal dialysis (APD): a dialysis machine fills + drains the abdomen while the patient is sleeping, performing 3-5 exchanges over 8-10h each night
38
Describe renal transplantation
Average wait: 3y Donor kidney transplanted into groin, with the renal vessels connected to external iliac vessels. Failing kidneys are not removed Need lifelong immunosuppression
39
List 7 complications of haemodialysis
Infection Endocarditis Stenosis at site Hypotension Cardiac arrhythmia Air embolus Disequilibration syndrome
40
List 10 complications of peritoneal dialysis
Peritonitis Catheter infection Catheter blockage Constipation Fluid retention Hyperglycaemia Hernias Back pain Malnutrition
41
Symptoms of renal failure not being adequately managed by RRT
SOB Fatigue + insomnia Pruritus Poor appetite Swelling Weakness Weight gain/ loss Abdominal cramps Nausea Muscle cramps Headaches Cognitive impairment Anxiety, Depression sexual dysfunction
42
Describe AV fistula
Surgical connection made between an artery + vein Strengthens + enlarges vein Allows higher rate of blood flow between vein + dialysis machine
43
List 3 disadvantages of AV fistula
Requires another temporary type of access during the healing + maturation phase Maturation may be delayed/ may fail to mature Needles are required to access the AV fistula for hemodialysis
44
2 elective indications for surgery in UC
Disease requiring maximal therapy Prolonged courses of steroids.
45
Absolute indication for proctocolectomy in UC
Dysplastic transformation of colonic epithelium with associated mass lesions
46
Surgery for emergency presentations of poorly controlled UC that fails to respond to medical therapy
Sub-total colectomy Excision of rectum has higher morbidity + is not performed in emergency setting. An end ileostomy is created Rectum stapled off + left in situ, or, if bowel very oedematous, brought to surface as a mucous fistula.
47
Proctocolectomy in UC and Crohn's
Removes colon + rectum Crohns: end ileostomy UC: Ileoanal pouch anastomosis (internal J pouch)
48
Proctectomy
Removes rectum
49
Colectomy
Removes colon Can form ileoanal pouch
50
3 Complications of ileoanal pouch
Anastomotic dehiscence Pouchitis Poor physiological function with seepage + soiling.
51
3 indications for surgery in crohns disease
Fistulae Abscess formation Strictures
52
Surgery for terminal ileal crohn's
Limited ileocaecal resections
53
Surgery for severe perianal/ rectal Crohns
Proctectomy
54
Why is ileoanal pouch formation not recommended in Crohns?
High risk fistula formation + pouch failure Recurrence of disease in internal pouch
55
What is a loop ileostomy used for?
Defunctioning of colon e.g. following rectal cancer surgery Does not decompress colon (if ileocaecal valve competent)
56
What is a loop colostomy used for?
To defunction a distal segment of colon Since both lumens are present the distal lumen acts as a vent
57

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