Liver and Renal

Question 1

What are some signs of chronic liver disease on examination?

Answer 1

Asterexsis
Brusing
Clubbing
Dupytrens
Erythema (palmar)
Fetor hepticus (breath smell) 
Gynaecomastia
Itching (pruritus)
Jaundice
Spider Nevae
Caput medusae
Raised JVP
AV fistulae (renal theraply)

Question 2

What do you look for in the mouth?

Answer 2

Pigmentation
Gum hypertrophy (medication post renal transplant can cause this)

Question 3

What would a right subcostal scar be from?

Answer 3

BIliary surgery

Question 4

Mercedes-benz scar?

Answer 4

Liver transplant

Question 5

Midline lapartomy scar?

Answer 5

GI or major abdo surgery

Question 6

Mcburneys incision?

Answer 6

Appendicetomy

Question 7

J-shaped incision?

Answer 7

Renal transplant

Question 8

Low transverse?

Answer 8

Gynae procedure

Question 9

Inguinal incision?

Answer 9

Inguinal hernia repair and vascular access

Question 10

Loin incision?

Answer 10

Nephrectomy

Question 11

What are the causes of hepatomegaly?

Answer 11

Cancer
Cirrhosis
Cardiac
- Congestive heart failure
- Constrictive pericarditis

Infiltration

Question 12

Summarise the causes of liver disesase

Answer 12

Alcohol
Auto-immune
Drugs
Viral
Biliary disease

Question 13

What are the causes of splenomegaly?

Answer 13

2H and 2I

portal Hypertension
Haematological

Infection
Inflammation

Question 14

What infections can cause splenomegaly?

Answer 14

EBV
Infectious mononucleosis
TB
Malaria
Infective endocarditis

Question 15

What are gastro presentations?

Answer 15

Abdo pain
Abdo distention
Change of bowel habit
GI bleed
Jaundice 
Ascites

Question 16

What is constant pain indicative of?

Answer 16

Inflammation

and -itis disease

Question 17

What are some causes of epigastric pain?

What from the history can help differentiate?

Answer 17

Peptic ulcer (?NSAID use)
GORD (better with antaacids)
Gastritis (retrosternal, ETOH)
Malignancy

Acute pancreatitis (gallstones, high amylase)

Pain from above - cardiac

Question 18

What are features of chronic pancreatitis?

Answer 18

Pain
Wt loss
loss of exocrine and endocrine function
normal amylase 
faecal elastase

Question 19

What are causes of RUQ pain?

Answer 19

Gallbladder:
Cholecystitis
Cholangitis
Gallstones

Liver:
Abscess

From above: basal pneumonia

Form left: peptic ulcer or pancreatitis

From right: pyelonephritis

Question 20

What are causes of RIF pain?

Answer 20

Gynae:
Ovarian cyst rupture, twist, bleed
Ectopic pregnancy

GI
Appendicitis
Mesenteric adentis
Colitis
Malignancy

Question 21

What are causes of suprapubic pain?

Answer 21

Cystisis

Urinary retention

Question 22

What are causes of LIF pain?

Answer 22

GI
Diverticulitis
Colitis (IBD)
Malignancy

Gynae:
Ovarian cyst rupture, twist, bleed
Ectopic pregnancy

Question 23

What are some causes of diffuse abdo pain?

Answer 23

Obstruction
Infection - peritonitis, gastroenteritis
IBD
Mesenteric ischaemia
Medical causes:
DKA
Addisons
Hypercalcaemia
Porphria
Lead poisoning

Question 24

What is porphyria?

Answer 24

Group of disorders caused by abnormalities in haem production
Can present with acute abdomen

Question 25

What can cause abdominal distension?

Answer 25

Fluid Flatus Fat, faeces, fetus

Question 26

What should you ask about when thinking about obstruction?

Answer 26

``` N and V Not opened bowel? High pitched tinkling bowel sounds Previous surgery - adhesions Tender irreducible hernia in the groin ```

Question 27

What are the causes of transudate ascites?

Answer 27

High protein | - Cirrhosis

Question 28

What causes pale stool?

Answer 28

Low stercobilinogen

Question 29

What causes the different types of jaundice?

Answer 29

Pre-hepatic - haemolysis or defective bilirubin conjugation Hepatic Post-hepatic - biliary

Question 30

What causes the different types of jaundice?

Answer 30

Pre-hepatic - haemolysis or defective bilirubin conjugation Hepatic - hepatitis Post-hepatic - biliary (pain), pancreatic cancer (painless)

Question 31

When do you get dark urine?

Answer 31

Conjugated bilirubin leaks and makes it way into urine in hepatitis Does not enter bowel so pale stools. Obstruction to flow.

Question 32

Why does bloody diarrhoea happen?

Answer 32

Loss of epithelial integreity

Question 33

What are the infective causes of bloody diarrhoea?

Answer 33

Infective colitis - Campylobacter - Haemorrhagic e. coli - Entamoeba histo - S - S

Question 34

What is thumb print sign?

Answer 34

Thickening of bowel | Thick haustral folds

Question 35

What is the lead pipe sign?

Answer 35

UC

Question 36

What is toxic megacolon?

Answer 36

Dilated colon more than 6cm with systemic signs

Question 37

How is a acute GI bleed managed?

Answer 37

``` ABC IV access Fluids G+S, X match OGD ```

Question 38

How is a variceal bleed from chronic liver disease treated?

Answer 38

ABs | Terlipressin

Question 39

What is the mangement of acute abdomen?

Answer 39

``` NBM Fluids Analgesic Anti-emetics Antibiotics Monitor vitals ```

Question 40

What investigations for jaundiced patients?

Answer 40

FBC, LFTs, CRP | Abdo USS after fast

Question 41

What is the management for ascites?

Answer 41

``` Diuretics NA restriction Fluid restriction Monitor weight daily Therapeutic paracentesis ```