CCC - Liver and Renal

Question 1

What can comes up is OSCE abdo?

Answer 1

• Chronic Liver Disease
• Chronic Kidney Disease
• Haematology clinic

Question 2

What is the ABCDEFGHIJ for abdo?

Answer 2

Asterixs (flap)
Brusing (clotting factors made in liver) 
Clubbing
Dupytrens
Erythhema (palmar)         
Fetor hepaticus
Gyanecomastia
Hair loss
I
Jaundice

Question 3

What features do you look for in the hands?

Answer 3

1. Asterixs (flap)
2. Brusing (clotting factors made in liver)
3. Clubbing
4. Dupytrens
5. Erythhema (palmar)
6. Leuconychia

Question 4

What features do you look for in the forearms?

Answer 4

1. av fistulae

2. current or previous renal replacement therapy

Question 5

What features do you look for in the head and neck?

Answer 5

1. anaemia
2. jaundice
3. Skin: jaundice, excoriation marks or spider naevi
4. Oral examination: pigementation, gum hypertrophy

Question 6

Why might there be gum hypertrophy?

Answer 6

on ciclosporine after renal transplant

Question 7

What do you look for on chest inspection?

Answer 7

1. Gynaecomastia
2. Hair loss
3. Excoriation marks
4. Spider naevi

Question 8

What do you look for on abdominal inspection?

Answer 8

1. Abdominal distension?
2. Caput medusae?
   - distended superficial abdominal veins
   - direction of flow in the veins below the umbilicus is towards the legs
3. Scars?

Question 9

What would a right subcostal scar suggest?

Answer 9

biliary surgery

Question 10

What would a mercedes-benz incision suggest?

Answer 10

liver transplant

Question 11

What would a midline laparomotmy scar suggest?

Answer 11

GI or any major abdominal surgery

Question 12

What would a McBurney’s incision suggest?

Answer 12

appendicetomy

Question 13

What would a J shaped incision suggest?

Answer 13

renal transplant

Question 14

What would a low transverse incision suggest?

Answer 14

gynae procesdure

Question 15

What would an inguinal incision suggest?

Answer 15

hernia repair, vascular access

Question 16

What would a loin incision suggest?

Answer 16

nephroectomy

Question 17

What are the causes of hepatomegaly?

Answer 17

1. Cancer: primary or secondary deposits
2. Cirrhosis (early, usually alcoholic)
3. Cardiac:
   - congestive cardiac failure
   - constrictive pericarditis
4. Infiltration

Question 18

What are the infiltration causes of hepatomegaly?

Answer 18

1. fatty infilatration
2. haemochromatosis
3. amyloidosis
4. sarcoidosis
5. lymphoproliferative diseases

Question 19

What are the causes of liver disease?

Answer 19

1. alcohol
2. autoimmune
3. drugs
4. viral
5. biliary disease

Question 20

What are the causes of splenomegaly?

Answer 20

1. H (portal Hypertension) - chronic liver disease
2. H (haematological) - haemolytic anaemia
3. Infection: infectious mononucleosis, TB, IE, malaria
4. Inflammation:

Question 21

If abdominal pain is constant what does it suggest?

Answer 21

inflammation

Question 22

If abdominal pain is colicky what does it suggest?

Answer 22

obstruction

Question 23

What are epigastric pain DDx?

Answer 23

• Stomach:
  1. peptic ulcer (NSAID use?)
  2. GORD (better with antacids)
  3. Gastritis (retosteronal, alcohol)
  4. Malignancy
• Pancreas
  1. acute pancreatitis (Hx of gallstones? high amylase?)

Question 24

What are surrounding epigastric pain DDx?

Answer 24

• Above: (heart) MI
• Below: (aorta) ruptured aortic aneurysm
• Right: (liver/gallbladder) cholecystitis, hepatitis

Question 25

What is acute pancreatitis associated with?

Answer 25

1. pain | 2. v high amylase

Question 26

What is chronic pancreatitis associated with?

Answer 26

1. chronic pain 2. weight loss 3. loss of exocrine function (malabsoprtion) 4. loss of endocrine function (diabetes) 5. normal amylase 6. faecal elastase (in stool sample)

Question 27

What are the RUQ pain DDx?

Answer 27

- Gallbladder: 1. cholecystitis 2. cholangitis 3. gallstones - Liver: 1. hepatitis 2. abscess

Question 28

What are the surrounding RUQ pain DDx?

Answer 28

1. Above: (lungs) basal pneumonia 2. Below: (appendix) appendicitis 3. Left: (stomach, pancreas) peptic ulcer, pancreatitis 4. Right: (kidney) pyelonephritis

Question 29

What are RIF pain DDx?

Answer 29

- GI: 1. Appedicitis 2. Mesenteric adenitis (common in children) 3. Colitis (IBD) 4. Malignancy - Gynae: 1. Ectopic pregnancy 2. Ovarian cyst rupture, twist, bleed

Question 30

What are suprapubic pain DDx?

Answer 30

1. cystitis | 2. urinary retention

Question 31

What is LIF pain DDx?

Answer 31

- GI: 1. Diverticulitis 2. Colitis (IBD) 3. Malignancy - Gyanecological: 1. ovarian cyst rupture, twist, bleed 2. ectopic pregnancy

Question 32

What are diffuse abdominal pain DDx?

Answer 32

1. obstruction 2. infection: peritonitis, gastroenteritis 3. inflammation: IBD 4. ischaemic: mesenteric ischaemia

Question 33

What are medical causes of diffuse abdominal pain?

Answer 33

1. DKA 2. Addison's 3. Hypercalacemia 4. Porphyria 5. Lead poisoning

Question 34

What does the celiac artery supply?

Answer 34

1. Stomach 2. Spleen 3. Liver 4. gallbladder 5. Dudoenum

Question 35

What does the superior mesenteric artery supply?

Answer 35

1. small intestine | 2. right colon

Question 36

What does the inferior mesenteric artery supply?

Answer 36

left colon

Question 37

What do the iliac arteries supply?

Answer 37

rectum

Question 38

When is amylase high?

Answer 38

in any acute abdominal pathology - esp high in acute pancreatitis

Question 39

When is lactate high?

Answer 39

problem with perfusion (ischaemia)

Question 40

When is bicarbonate low?

Answer 40

metabolic acidosis

Question 41

What is SBP?

Answer 41

spontaneous bacterial peritonitis - complication of liver disease

Question 42

What is the ascites neutrophil count like in SBP?

Answer 42

>250cells/mm^3 (need antibtioics)

Question 43

What are causes of abdominal distension?

Answer 43

1. Fluid 2. Flatus 3. Fat 4. Feaces 5. Fetus 6. F big tumour

Question 44

What may cause fluid abdominal distention?

Answer 44

Ascites: - shifting dullness - features of liver disease

Question 45

What may cause flatus abdominal distension?

Answer 45

Obstruction: - nause and vomiting - not opened bowel - high pitched tinkling bs - previous surgery (adhesions) ? - tender irreducible femoral hernia in groin ?

Question 46

What are transudate causes of ascites?

Answer 46

1. cirrhosis 2. cardiac failure 3. nephrotic syndrome

Question 47

What are the exudate causes of ascites?

Answer 47

1. malignancy (abdominal, pelvic, peritoneal mesothelioma) 2. infection e.g. TB, pyogenic 3. Budd-Chiari syndrome (hepatic vein thrombosis), portal vein thrombosis

Question 48

What are three causes of jaundice and examples?

Answer 48

1. prehepatic: haemolysis, defective conjugation 2. hepatic: hepatitis 3. post-hepatic: CBD obstruction

Question 49

What are causes of pre-hepatic jaundice?

Answer 49

1. haemolysis | 2. gilbert's syndrome

Question 50

What is the mechanism of pre-hepatic jaundice?

Answer 50

decreased glucuronidation so increased unconjugated bilirubin

Question 51

What is the mechanism of hepatocellular jaundice?

Answer 51

conjugated bilirubin leaks out of hepatocytes and loose in urine so dark urine

Question 52

What is the mechanism of post-hepatic jaundice?

Answer 52

conjugated bilirubin leaks out hepatocytes giving dark urine | not getting to large bowel have decreased stercobilinogen so pale stool

Question 53

What does dark urine and pale stool suggest?

Answer 53

post-hepatic jaundice