Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine > PACES > Flashcards

PACES Flashcards

1
Q

Causes of chronic liver disease

A

Most common:
1. Alcoholic liver disease
2. NAFLD/NASH
3. HCV (and HBV)
Others:
4. Congenital - HH, wilson’s, alpha 1-ATD, CF
5. AI - AIH, PSC, PBC
6. Drugs - methotrexate, amiodarone, isoniazid
7. Neoplasm - HCC, mets
8. Vasc - Budd Chiari, RHF, constrictive pericarditis

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

Complications of chronic liver disease

A
  1. Liver failure/decompensation = portal HTN + jaundice
  2. Portal HTN - SAVE (splenomegaly, ascites, varices, encephalopathy)
  3. SBP
  4. HCC
  5. Coagulopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Features of chronic liver disease

A
  1. Signs of decreased oestrogen metabolism - gynaecomastia, decreased pubic hair, testicular atrophy, palmar erythema, spider nevi.
  2. Decreased synthetic action - coagulopathy (bruising), cachexia, leuconychia
  3. Features of portal HTN/decompensation - SAVE (splenomegaly, ascites, varices, encephalopathy) + jaundice.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes of ascites

A

Most common: 3C’s - cirrhosis, carcinomatosis, CHF

1) SAAG greater than 1.1: a. GI - cirrhosis or portal vein occlusion. b. cardiac - RHF
2) SAAG less than 1.1: a. Neoplams, b. infective (SBP, TB), c. Metabolic (low prot - nephrotic, protein loosing enteropathy, malnutrition), d. endocrine (hypothyroid), e. Inflammatory (pancreatitis, peritonitis).

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

Completion of a patient with ascites

A
  1. Pleural tap for MC&S + Ziehl-Neelson stain, cytology and biochemistry. SAAG.
  2. Urine dip (nephrotic syndrome)
  3. Liver screen (cirrhosis)
  4. USS + PV duplex (portal thrombosis)
  5. Cardio exam and echo/ECG (RHF)
  6. Bloods: FBC (WCC), amylase, TFTs, U&E, LFTs (albumin), glucose, INR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Management of patient with ascites

A
  1. Conservative - stop EtOH, weigh: reduction max 0.5kg/day, fluid restrict max 1.5L/day, Salt restrict 40-100mmol/day.
  2. Medical - spironolactone. Frusemide if poor response.
  3. Interventional - drainage with pig tail catheter. Replace albumin. TIPPS is refractory.
  4. Surgical - liver tx.
    * If SBP - tazocin + cipro +/- long term cipro prophylaxis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Top 3 causes cirrhosis

A

Alcoholic liver disease, NAFLD, HCV

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

Top 3 causes of ascites

A

CCF, Cirrhosis, Carcinomatosis

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

Top 3 causes of medical jaundice

A

Cirrhosis, Haemolysis, gallstones

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

Causes of medical jaundice

A

Top 3 = Cirrhosis, Haemolysis, gallstones
Pre hepatic: Haemolysis (AIHA, HS, SCD. Also Malaria, PNH, G6PD…).
Hepatic: Chronic liver disease, Hepatitis (viral, EtOH), Drugs (Paracetamol, anti-TB, Statins).
Post-hepatic: Gallstones, Pancreatic CA, porta hepatis LN (TB, Ca)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Tests/Ix for medical jaundice

A
  1. Urine dip: BR, Hb, urobilinogen.
  2. Blood: Haemolytic - FBC, DAT, Hb electrophoresis; hepatic - full liver screen, clotting; U&E
  3. US, PV duplex, MRCP, CT, MRI
  4. Liver biopsy (do clotting first)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management for medical jaundice

A

Tx cause.
Pre-hepatic - splenectomy
Hepatic - stop EtOH, antivirals/supportive, avoid drugs.
Post-hepatic - ursodeoxycholic acid, receive obstruction.

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

Indications for a liver transplant

A
  1. Cirrhosis
  2. Acute hepatitis (paracetamol, viral)
  3. Hepatocellular carcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Differentials of a mercedez benz scar

A
  1. Hepatic transplant
  2. Whipple’s procedure
  3. Upper GI surgery (radical gastrectomy)
  4. Bilateral adrenectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Differentials for a rooftop scar

A
  1. Abdominal aorta access
  2. Partial hepatectomy
  3. Pancreatic surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Causes of hepatomegaly

A

Top: Chronic liver disease, hepatitis, venous congestion 2º to heart failure.
Other:
1. Infective: malaria and leptospirosis
2. Mass effect: cystic disease, abscess, neoplasm
3. Granulomatous disease: sarcoid, PSC, IBD, drugs, infections (TB…), neoplastic (HL, NHL…)
4. Congestion: constrictive pericarditis, TR, Budd chiari
5. Metabolic: gaucher’s, amyloidosis…
6. Haematological: SCD, thalassemia
7. Non-abnormal; hyperexanded chest or Reidls lobe

17
Q

Features to note on palpation of an enlarged liver

A
  1. Confirm liver: location, moves down on inspiration, dull to percussion, can’t get above it.
  2. Features: TAPE to measure Size (mnemonic)
    a) Size - percuss above and below.
    b) Edge - smooth or nodular
    c) Pulsatile
    d) Tenderness
    e) Auscultate for bruit (HCC)
18
Q

management of hepatomegaly

A

Identify and treat cause.

19
Q

Causes of splenomegaly

A
  1. Infective: a) protozoal: malaria, leishmaniasis, hydatid cyst b) Bacterial: IE, TB, c) viral: EBV, CMV, HIV, hepatitis
  2. Myeloproliferative: MF, CML
  3. Lymphoproliferative: CLL, lymphoma
  4. Haematological: HS, thalassaemia major, SCD (children)
  5. Infiltrative: amyloidosis, gauchers
  6. Connective tissue: RA, SLE,
  7. Portal HTN
  8. Other: Felty’s, sarcoidosis
20
Q

Causes and definition of massive splenomegaly

A 
More than 20cm
Causes (M's)
1. Malaria
2. MF
3. LeishManiasis
4. cMl
(5. Gaucher's)
21
Q

Investigations of splenomegaly

A
  1. Hx + cardio/resp exam (sarcoid/IE)
  2. Bedside - urine dip (Hb and prot), Obs (temp)
  3. Bloods -
    a) standard FBC, LFTs, U&E and urate,
    b) Film - thick and thin (CLL, malaria, spherocytes, poikilocytes…)
    c) Full liver screen (clotting, virology…)
    d) Chromosomal analysis
  4. Imaging - US + PV duplex, CT/MRI/chest XRAY
  5. Biopsy - LN or BM…
22
Q

CML examination findings

A
  1. Massive splenomegaly
  2. Bruising + infection
  3. Hypermetabolism - FLAWS
  4. Gout
23
Q

CML investigations (and predicted results)

A
  1. Bloods - anaemia, thrombocytopenia, ++ immature granulocytes, hyper viscosity, high urate.
  2. Bone marrow - Ch analysis - Ph Ch (9:22 translocation) BCR-ABL 80% of cases.
24
Q

Management of CML

A
  1. Supportive + haematology referral
  2. Imatinib (80% 5 year survival)
  3. Allogenic SCT
25
Q

MF examination findings

A
  1. Massive splenomegaly
  2. Brusing + infection
  3. Hypermetabolism - FLAWS
26
Q

MF investigations (and predicted results)

A
  1. Bloods - anaemia, thrombocytopenia, lymphopenia
  2. Film - leukoerythroblastic with teardrop poikilocytes
  3. Bone marrow - dry tap - trephine biopsy
  4. 50% JAK 2+ve
27
Q

Management of MF

A
  1. Supportive: blood products
  2. Splenectomy
  3. Allogenic BMT
    mean survival = 5 years
28
Q

Features of splenomegaly.

“The mass in the LUQ was consistent with the spleen because….”

A
  1. Moved inferiorly on inspiration
  2. Enlarged towards the RIF
  3. Had a medial notch
  4. Was dull to percussion
  5. I could not get above it.
29
Q

Functions of the spleen

A
  1. Extramedullary erythropoiesis
  2. Blood product storage/sequestration
  3. Blood product breakdown - RBC, WBC
  4. Phagocytosis of opponisized bugs
  5. Production of antibodies
30
Q

Hyposplenisms causes

A
  1. Splenectomy
  2. SCD
  3. Coeliac disease
  4. IBD
31
Q

Mx of hyposplenism

A

Acutely post-splenectomy - aspirin prophylaxis
Chronically:
1. Vaccinations: HiB, Men C, Influenza, Penumovax
2. Daily pen V or erythromycin.
3. Alert card or breacelet

32
Q

Indications for splenectomy

A
  1. Trauma
  2. Rupture e.g. EBV
  3. AIHA
  4. ITP
  5. HS
  6. Hypersplenism
33
Q

Causes of hypersplenism

A
  1. All causes of splenomegaly (as this causes pooling) - infective, lymphoproliferative, myeloproliferative, infiltrative, portal HTN, haematological, connective tissue
  2. SCD - splenic sequestration crisis.

Medicine (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions