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What is acute kidney injury?

-Significant decline in renal function over hours or days manifesting as an abrupt and sustained increase in serum urea and creatinine


What are pre-renal causes of AKI?

-Renalvascular compromise eg NSAIDs, ACE I, renal artery stenosis


Give the main causes of renal AKI

-Acute tubulonecrosis caused by ischeamia, hypertension, thrombotic thrombocytopenia purpura
-Interstitial nephritis by drugs (NSAIDs, Abx) and toxins
-Nephritic syndrome


Post Renal causes of AKI

-Stones, neoplasm, stricture, prostate


Describe some possible clinical signs of an AKI

-Altered BP
-Raised JVP
-Postural hypotension
-Raised Urea, creatinine, low urine output, acidosis/hyperkalaemia


What investigations would you do in AKI?

-Bloods -> FBCs, U+Es, LFTs, glucose, Ca, clotting, ESR
-ABG to look for acidosis, hypoxia and hyperkalaemia
-urine dip
-ECG, CXR and renal US


Describe the ECG features in order of hyperkalaemia

-Peaked T waves
-Flattened P waves
-Increased PR interval
-Widened QRS


Describe the stages of alcoholic liver disease. At what stage is it irreversible?

-Fatty liver -> hepatitis -> cirrhosis


Which liver enzymes are commonly raised in alcoholic liver disease?



What is liver cirrhosis?

-Hepatocellular damage producing areas of nodular regeneration separated by fibrous septae


List some clinical signs of Alcoholic liver disease

- Hands -> Clubbing, leuconychia (low albumin), dupytens contracture, palmar erythema,
-Face -> pallor (ACD)
-Trunk -> Spider naevi, gynaecomastia (decreased liver metabolism)
-Abdo -> hepatosplenomegaly, caput medusa, ascites
-General -> jaundice, bruising (coagulopathy), anorexia


What is portal hypertension? Describe the main features

-Raised portal blood pressure >20mmHg
-SAVE (splenomegaly, ascites, varices (oesophageal, caput medusa, worsening piles) and encephalopathy


Describe portosystemic shunting in portal hypertension. Give the vessels involved in all 3 varices

-Raised portal pressure causes a backflow and increased pressure of blood as blood cannot enter portal system. portal vessels become engorged and dilated causing shifting of blood from the portal system into the systemic system.
-Oesophageal -> Left gastric vein to inferior oesophageal veins
-Caput medusa -> peri-umbilical to superficial abdo
-Haemorrhoids -> superficial rectal to inferior/middle rectal


What can be confused for caput medusa on the abdomen and how do you tell these apart?

-IVC obstruction
-blood flow down below umbilicus = portal hypertension
-Blood flow up below umbilicus = ivc obstruction


Why does portal hypertension cause encephalopathy?

-Decreased blood flow through liver decreases detoxification of blood.
-Build up of toxins in systemic system including ammonia ->cross bbb -> astrocytes clear causing glutamate to glutamine -> osmotic imbalance -> cerebral oedema


Describe the pathophysiology of ascites in liver disease

-Back pressure due to accumulation of blood causes increased hydrostatic pressure leading to fluid exudation. This causes a decrease in circulating volume and RAAS activation which enters a cycle of increased exudation and further RAAS activation. Also decreased albumin and impaired aldosterone metabolism


In broad terms what is anaemia? What general symptoms/signs does it produce?

-Decreased capacity of the haemoglobin to carry oxygen
-Fatigue, pallor, palpitations, light headedness


What are the causes of microcytic anaemia?

-Anaemia of chronic disease
-Iron deficiency Anaemia
-Lead Poisoning
-Sideroblastic anaemia


Describe causes of normocytic anaemia

-Recent blood loss
-Bone marrow failure
-Early ACD


What are causes of macrocytic anaemia?

-Vit B12 deficiency
-Folate deficiency
-liver disease


Give some causes of haemolytic anaemia

-Hereditary spherocytosis/elliptosis
-G6PD deficiency
-Destruction by mechanical heart valves


Give 3 differentials for causes of iron deficiency anaemia

-Poor diet


Give 2 signs specific for iron deficiency anaemia

-Angular stomatitis


What are the causes of b12 deficiency?

-Bacterial overgrowth syndrome (increased use of b12)
-Pernicious anaemia


What are the causes of folate deficiency?

-Poor diet


What are the specific symptoms in b12 deficiency?

-Peripheral neuropathy


Describe the pathophysiology of asthma

-Bronchial hypersensitivity causing an exaggerated response to normally non-allergenic non-noxious stimuli resulting in mucosal oedema, mucus hypersecretion and bronchoconstriction which leads to reversible airway narrowing. Over time this lead to goblet cell hyperplasia, smooth muscle hypertrophy and airway remodelling .


What cellular/immune components are involved in asthma

-Histamine release from mast cells
-IgE and eosinophils


Name some precipitants of asthma

-Atopy -> t1 hypersensitivity to dust, pollen, animals
-Stress -> cold air, viral urti, exercise, emotion
-Toxins -> smoking, hairspray


What are the signs and symptoms of asthma

-Cough +/- sputum
-Diurnal variation