15/10/21 Flashcards
LFT Numbers for Cholestatic Pattern
ALP >200 + ALP > 3xALT
LFT Numbers for Hepatocelluliar Pattern
ALT >200 + ALT>3xALP
Causes of Cholestatic Pattern of Deranged LFTS (4 points)
Pregnancy
Bilary Obstruction
Drugs - erythromycin, oestrogen
Malignancy
Causes of Hepatocellular Pattern of Deranged LFTs (7 points)
Infection (EBV, CMV, Hep A, Hep B, Hep C) Alcohol -> Often AST>2xALT NAFLD Drugs Metal Hypoxia Autoimmune
Factors used in calculation of Absolute CV Disease Risk. (8 points)
- Gender
- Age
- Systolic Blood Pressure
- Smoking Status
- Fasting Total Cholesterol
- Fasting HDL Cholesterol
- History of Diabetes
- ECG LVH
Demographiecs that are automatically high CVD risk without using the calculator (7 groups)
- Diabetes + Age >60yo
- Diabetes with microalbuminuria (urinary ACR >2.5mg in male and >3.5mg in female)
- Moderate or Severe CKD → persistent proteinuria or eGFR <45)
- Previous diagnosis of Familial Hypercholesterolaemia
- Systolic Blood Pressure ≥ 180mmHg or Diastolic Blood Pressure ≥ 110 mmHg
- Serum Total Cholesterol > 7.5mmol/L
- Aboriginal or Torres Strait Islanders adults ≥ 74yo
Options for 1st line BP lower medications? What should not be used as a 1st line BP lowering medication?
ACEi, ARB, calcium channel blocker, thiazide or thiazide like diurectics
NOT beta-blocker
Prescription for gout prophylaxis.
- Allopurinol 50mg PO daily for 4/52, then increase by 50mg every 2-4 weeks to achieve target serum uric acid concentration, up to maintenance maximum of 900mg daily
General Lifestyle Advice to reduce absolute CVD risk. (7 points)
Diet → varied diet rich in vegetables, fruits and whole grains
Fats → limit food containing trans and saturated fats
Alcohol → limited alcohol to ≤ 2 standard drinks/day.
Smoking → smoking cessation, consider nicotine replacement therapy
Exercise → At least 30min exercise on most or preferably every day of the week
Weight → BMI <25, Waist Circumference <94cm
Salt → Limit salt to <6g/day
Differential Diagnoses of Acute Pancreatitis (6 points)
- Peptic Ulcer Disease
- Biliary Pathology: Choledocolithiasis or Cholangitis or Cholecystitis
- Perforated Viscus
- Intestinal Obstruction
- Mesenteric Ischaemia
- Hepatitis
Investigations for Acute Pancreatitis (7 points)
- FBE - WCC
- LFTs
- Amylase → >3xnormal
- Lipase → >3xnormal
- Hypoglycaemia
- Hypocalcaemia
- CT
Management of Acute Pancreatitis (5 points)
- Nil by Mouth
- Large Bore Cannulas x2
- Fluid Resuscitation 500-100ml N. Saline
- Analgesia -> Morphine 2.-5mg IV/Fentanyl 25-50microg IV
- Ondansetron 4-8mg IV/Metoclopramide 10mg IV
Causes of Splenomegaly (5 points. there are 16…)
Massive
- Chronic Myeloid Leukaemia
- Myelofibrosis
- Primary Lymphoma of the Spleen
- Kal-azar
- Malaria
- Hairy Cell Disease
Moderate
- P - portal hypertension
- L - lymphoma
- L - leukaeamia
- T - thalassemia
- S - storage disease
Mild
- Other myeloproliferative disorders
- Haemolytic anaemia
- Infection → viral (infectious mono, hepatitis), bacteria (infective endocarditis)
- Infiltration - amyloidosis, sarcoidosis
- CTD/Vasculitis → SLE, RA, PAN
- Megaloblastic Anaemia
Symptoms of Splenomegaly (5 points)
- Early Satiety
- Abdominal Fullness or Distension
- Pain referred to chest or left shoulder
- B Symptoms → weight loss (may have malignancy → lymphoma, leukaemia, myeloproliferative neoplasm, metastatic solid tumour)
- Hepatitic Fibrosis or Cirrhosis
Investigations for Splenomegaly (4 points)
- FBE + blood film
- Immature + Abnormal WBC
- Cytopenias
- Teardrop Cells
- Spherocytes
- LFTs
- U/S → for assessing size of splenomegaly
- CT or MRI → evaluate splenic involvement by a systemic process or a focal lesion
