Brainscape's Knowledge GenomeTM

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


See full index

PACES > abdo > Flashcards

abdo Flashcards

1
Q

Autodomal polycystic kidney disease main examination sign

A

Bilateral ballotable masses in the flanks which I am able to get above
does not move with respiration

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

Autodomal polycystic kidney disease
BONUS examination signs

A

Hepato or splenomegaly - can have cysts in the liver, pancreas, spleen, epididymis or thyroid

Features of renal impairement - fluid status, RRT

Third cranial nerve palsy - given 5% prevelance of anneurysm, but >20% if over 60. Rupture is assx with uncontrolled hypertension

Loin pain may occur due to renal haemorrhage, calculi or infection

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

inheritance of PKD

A

ADPKD type 1 - 80% have a mutational chromosome 16 (Sixteen/cysteen?)

ADPKD type 2 - 15% have a mutational chromosome 4 - (less severe, later onset, fever cysts)

ARPKD aka, infantile PKD - RECESSIVE. 30% die within first week. Mutations in PKHD1 chromosomal 6

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

Management of PKD

A

• BP - ACEi, low salt. Limited evidence re high fluid low protein

• Mx of hyperlipidaemia
CKD is a major risk factor for ischaemic heart disease

• CKD stage 1–3 - vasopressin receptor antagonist, eg tolvaptan, may be of use

• Haemodialysis , can do at home sometimes
• Transplant list or donated from family

• Family testing and genetic counseling

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

indications for nephrectomy in PKD

A

Avoid if possible

Consider if
• need to make room for transplant
• progression to renal cell carcinoma (although this is not common)
• chronic pain
• chronic infection
• large and significant haematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

incidence of PKD progression to renal cell carcinoma

A

about 50% higher than gen population, although this “is not a common sequeallae”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

in abdo exam don’t feel for…

A

hernias /inguinal lymphad

but do assess Axillary and Neck lymph nodes

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

1-3 mm diameter macules which may become larger papules over time on trunk.

Typical bright cherry red colour but can appear blue or purple.

They are non-blanching

A

Campbell de Morgan Spots aka Cherry angioma

unknown eitology

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

end of bed abdo exam

A

• Jaundice
• Tense ascites / caput medusae
• Tattoos?
• Nutritional status
• Scars?
• Meds?

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

hands abdo exam

A

• Thinning of skin? - steroid use from liver transplant/autoimmune liver sisease
• Bruising - coagulopathy from liver failure
• Dupuytrens on palms - feel, then spread out palms of hands to look for subtle updrawing of ring finger
• Palmar erythema - could be a few things, incl chronic LD
• Leukonychia - hypoalbuminaemia
• Spoon nails (koilonychia) in IDA
• Fine tremor - alcohol withdrawal, tacrolimus tox
• hepatic flap of hepatic encephalopathy

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

Palmar erythema

A

• Chronic liver disease
• Chronic hypoxia causing Polycythaemia
• Thyrotoxicosis
• Pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Causes of Dupuytren’s contracture

A

Hereditary

Smoking

Alcohol and other liver disease

Epilepsy (probably due to Meds)

Diabetes (~20%, no relationship with diabetic control)

SHADE mnemonic

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

Leukonychia

A

double white transverse line = Hypoalbuminaemia, liver disease, malnutrition

Half and half nail = CKD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Mercedes Benz scar

A

liver transplantation
Can also be done with J shaped incision aka makuuchi incision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Chevron / rooftop incision

A

the extension of the incision to the other side of the abdomen; used to access the oesophagus, the stomach, and the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Chevron / rooftop incision

A

to access the oesophagus, the stomach, and the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Fine tremor with Mercedes Benz scar?

A

Could be liver transplant with tacrolimus toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Face examination in abdo exam

A

• Parotid swelling
• Jaundice
• Angular cheilitis /stomatitis (usually fungal infection but can be deficiency in riboflavin (vitamin B2)
• Conjuctival pallor - anaemia (i.e. chronic GI blood loss, inflam bowel disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

inside mouth in abdo exam

A

Inside mouth
• aphthous ulcers - Crohn’s
• Denitition
• Tongue - candida? Atrophic glossitis? raw red tongue of B12 def
• central cynosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Atrophic glossitis

A

Partial or complete absence of filiform papillae on the dorsal surface of the tongue

Many causes, usually related to IDA, pernicious anemia, B vitamin complex deficiencies, unrecognized and untreated celiac disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Virchow’s node

A

L supraclavicular node
- called Troisier sign

signal node for the spread of gastric cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

fistula examination steps?

A

• Type - radiocephalic (most), brachiocephalic, upper arm transposed basilica fistula
• Signs of infection
• Feel for thrills (active or not) / listen for bruits
• Sign of recent needle punctures (regular dialysis)

Combine with other info, e.g. J shaped + needle punctures = not functional transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

fistula examination steps?

A

• location
• feel for thrills (active or not)
• sign of recent needle punctures (regular dialysis)

Combine with other info, e.g. J shaped + needle punctures = not functional transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how do you imagine this man was diagnosed with PKD?

A

Usually asymp until 4th decade so most are found via screening service for family members who have PKD

This hasn’t always been the case, so it may that this gentleman was diagnosed via routine blood tests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

benefits of screening for PKD

A

There’s also now a treatment called tolvaptan, which can slow the growth of cysts and may be beneficial in some cases.

Reduce cardiovasc disease - Management of BP, Lipids etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

MoA of Tolvaptan

A

competitive antagonist at vasopressin V2 receptors…
…can slow the growth of cysts, reducing overall kidney growth and preserving kidney function for longer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

poor prognostic features of PKD

A

• Declining eGFR
• Proteinuria
• Early onset
• Male gender

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

why is high fluid intake advised for PKD

A

Suppresses antidiuretic hormone (ADH) levels

ADH levels are correlated with cyst growth
hence use of Tolvaptan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

signs that may indicate uraemia

A

• scratch marks - uraemic pruritis
• uremia flapping tremor
• chest pain - uraemic pericarditis
• crystallized urea deposits (now very rare)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

isolated splenomegaly likely diagnosis

A

if no lymphad, travel, no evidence of anaemia / chronic liver disease… Top 3 CML, myelofibrosis, malaria

then Likely diagnosis - form of chronic haemolysis, like hereditary spherocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Causes of MASSIVE splenomegaly

A

• Myeloproliferative disorders
- chronic or acute myeloid leukaemia
- myelofibrosis

• Malaria chronic

• Visceral leishmaniasis

• Gaucher disease (lipid build up - think re Ashkanazi Jew)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Mechanism of splenomegaly in chronic liver disease

A

cirrhosis, causing blockage of blood flow, portal vein back-up and portal hypertension, causing spleen to become engorged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

causes of splenomegaly

A
  1. INFILTRATION - malig or benign
    • myelo/lymphproliferative disoders
    • lymphoma
    • amyloidosis
    • sarcoidosis
    • thyrotoxicosis
    • gaucher disease (lipid build up, Ashkanazi Jew)
  2. INCREASED function
    • increased removal of defected RBC
    • spherocytosis
    • thalassaemia
    • dietary anaemia
    • sickle cell

• immune hyperplasia
- Malaria (recent travel to africa - also look for anaemia)
- visceral leishmaniasis
- subacute bact endocartiditis
- glandular fever (examine throat)
- Brucellosis (farmer)

• Disordered immunoregulation
- RA , with FElty’s
- SLE
- Sarcoid

  1. ABNORMAL flow
    • Cirrhosis
    • Vascular problem like Hepatic/portal vein obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Large spleen - what investigation

A

FBC with blood film

If any suspicion of haem malig - CT TAP plus bone marrow aspirate, LN biopsy

If African deent, FBC plus Thin and Thick films - for sickle cell and malaria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Indications for liver transplants

A

• Cirrhosis
• Hepatocellular carcinoma
• Acute hepatic failure (hepatitis A and B, paracetamol overdose)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

scoring system for liver transplant in chronic disease

A

United Kingdom Model for End-Stage Liver Disease (UKELD) = Na, Cr, Bili, INR,
predicts prognosis of patients with cirrhosis / CLD
Same as MELD but that includes if dialysis twice in last week

score of 49 = 9% one-year risk of mortality, and is the minimum score to be added to transplant waiting list in UK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

hemochromatosis diagnosis investigation

A

routine bloods - ferritin, transferrin saturations

if raised then HFE gene testing

INR is a good marker of liver synthetic function
Remember HbA1c, Alpha fetoprotein, echo, XR of joints,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

liver transplant scar?

A

Mercedes Benz
or J shaped incision aka Makuuchi incision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

See a liver transplant scar, what is important?

A

1) What is the scar?

2) Is transplant functioning?
- signs of CLD
- Gynaecamastia and Dupytrens persist
- evidence of Portal hypertension (Caput medusa, splenomegaly)…but spleen can remain enlarged
- hepatic decompensation - asterixis, ascites, jaundice -but could be extrahepatic jaundice

3) SE from immunosuppression?
- signs of infection
- Skin - sebhorric warts, actinic keratosis, skin malig/scars
- Steroid SE -evidence of diabetes, Cushingoid
- Tremor - tacrolimus
- Gum hypertrophy - cyclosporin (but rare)

4) Underlying eitiology?
- venesection scar? - haemochromatosis
- tattooes - hepatitis?
- signif xanthelasma - primary biliary cholangitis
- scars for prev trachae, post op drain, or ascitic drains

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what signs of CLD persist following liver transplant?

A

Gynaecamastia and Dupytrens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Signs of portal hypertension

A

caput medusa
splenomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Liver transplant contraindications

A

• IVDU
• ongoing alcohol excess (abstinence is mandatory in ALD)
• Signif medical / psychiatric comorbs

• Hx of prior malig would be strongly considered…
Age alone is not a contra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

criteria for liver transplant in acute hepatitis

A

If suspected survival without transplant, is less than that with

Estimated mortality: Maddrey score and Glasgow Alcoholic Hepatitis score (GAHS)

(chronic is UKELD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what type of drug is tacrolimus?

A

calcineurin inhibitor

( same as cyclosporine and pimecrolimus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

immunosuppression post liver transplant

A

initially steroids, but these are weaned down
then calcineurin inhibitor (e.g. tacrolimus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

liver transplant survival stats

A

90% alive at one year
75% alive at three year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

complications of liver transplant

A

1) Rejection (particularly early)

2) SE from immunsuppression
- infections
- increased risk of skin malig
- metabolic syndrome

3) Acute or chronic kidney disease
- from calcinuerin inhib
- diabetes
- hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

management of ascites + pyrexia

A

If ascites corrected neutrophil count >250
….treat as SBP

Gram stain and culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

causes of liver disease?

A

UK common
- alcoholic (most common in UK)
- non-alcoholic fatty LD

Globally most common
- viral hepatitis

Autoimmune
- autoimmune hepatitis
- primary biliary cholangitis
- primary sclerosing cholangitis

Inherited
- haemochromatosis
- wilson’s disease
- alpha 1 anti trypsin

Drugs
- paracetamol OD
- methotrexate
- amiodarone

  • HCC
50
Q

Differential diagnoses of ascites

A

serum-ascites albumin gradient
SAAG = (serum albumin) – (ascites albumin)

≥11g/L - Portal hypertension (97%) accuracy
- cirrhosis (usually clear)
- CCF
- Budd Chiari
- Meig’s

< 11 g/:
- Malig - peritoneal carcinoma (most common)
- Pancreatitis
- Nephrotic syndrome
- TB

51
Q

causes of ascites by category

A

Need serum-ascites albumin gradient (SAAG) but categorised as:

1) Vascular
- Portal hypertension from cirrhosis (most common)
- Budd chiari
- CCF
- Constrictive pericarditis

2) Low Alb
- Nephrotic syndrome

3) Peritoneal disease
- Meig’s - Pl Eff, ascites, benign ovarian tumour
- Infectious peritonitis (TB / fungal)
- Malig

3) Misc
- pancreatic leak
- PD related
- Advanced hypothy?

52
Q

To complete my Abdo Exam i would like….

A

to examine

hernial orifices
external genitalia
rectal examination
urinalysis

53
Q

tests for liver synthetic function

A

albumin and INR

most helpful blood indicators of cirrhosis in terms of hepatic function

54
Q

USS of liver in pt ascites?

A

Echotexture of liver
Portal vein patency

55
Q

What is medication: Pentasa?

A

aka Mesalazine
5-aminosalicylic acid

56
Q

indications for surgery in inflammatory bowel disease

A

• Toxic dilatation /megacolon
• Perforation
• Haemorrhage
• Failure of medical therapy
• Abscess

(more common in Crohn’s due to transmural inflammation, 80% at some point need surgery)

57
Q

Management of Crohn’s flare

A

• Weaning course of steroids
• Azathioprine (immunosuppressant)
• Reg FU, and nurse specialist
• Dietician

58
Q

Risk of cancer in Ulcerative colitis and Crohn’s
and screening

A

Increased risk, but more so in UC than Crohn’s

IBD >10yr, then regular endoscopy

59
Q

what is the most common Extra-intestinal feature of inflammatory bowel disease?

A

• Arthritis
Usually asymmetrical, pauciarticular (less than 4joints) is related to disease activity

60
Q

management of Crohn’s vs Ulcerative Colitis to induce remission?

A

Crohn’s:
• glucocorticosteroids first line
+/- azathioprine
• aminosalicylate (ASA) if steroids not an option
• or infliximab (give aza or methotrexate so body doesn’t make antibodies to inflix)

UC
• ASA first line, topical if possible
• Except in severe - IV steroids +/- ciclosporin or surgery

61
Q

surgery in Crohn’s vs Ulcerative colitis

A

Surgery is more common in Crohn’s due to transmural inflammation… up to 80% require surgery at some point

Colectomy can be curative in UC

62
Q

What antibodies tests would you request for chronic liver failure?

A

PRIMARY BILIARY CHOLANGITIS
• Anti-mitochondrial antibody (AMA)

AUTOIMMUNE HEPATITIS
• Antinuclear Antibodies (ANA)
• Smooth muscle antibody
• IgG
• Anti-Liver-Kidney Microsomal (LKM) antibody (type 2 AIH)

• AFP tumour markers - HCC

63
Q

Antibodies in primary biliary cholangitis

A

Anti-mitochondrial antibody (AMA)

64
Q

primary biliary cirrhosis treatment

A

Ursodeoxycholic acid
Can relieve symps and improve prog

Can do transplant

65
Q

causes of jaundice

A

PRE- (haemolytic)
• Hereditary Spherocytosis
• Sickle cell
• Malaria
• Bacteraemia
• g6pd deficiency

INTRA- hepatocellular disease (cell failure) or intrahepatic obstruction
• Cirrhosis
• Hepatitis
• Alcohol
• Liver cancer
• Gilbert’s

POST-
• Intrahep / extra hepatic bile duct stones
• Gall bladder stones

66
Q

Commonest causes of end stage renal failure

A

Diabetes
Hypertension
PKD

67
Q

What are the potential barriers to renal transplant?

A

• Donor matching
• Active or recent malig
• Ongoing deep-seated infection (especially in diabetic patients)
• Active vasculitis
• Severe obesity due to technical difficulty

68
Q

SE from immunosuppression?

A
  • signs of infection
  • Skin - sebhorric warts, actinic keratosis, skin malig/scars
  • Steroid SE -evidence of diabetes, Cushionoid, brusing
  • Tremor - tacrolimus
  • Gum hypertrophy - cyclosporin (but rare)
69
Q

Renal transplant on Mycophenolate
What do you need to tell patient

A

• Neutropenia and thrombocytopenia so bloods
• CXR (pulmonary fibrosis risk)
• Stop 6 weeks before trying for baby, and not during breast feeding

70
Q

what’s the purpose of simultaneous pancreas kidney transplant

A

for ESRF in T1DM (and sometimes Insulin-dep T2DM)
intends to cure both the patient’s diabetes and end stage renal failure

—-> reduces risk of the vascular complications of diabetes (exept unclear if helps diabetic retinopathy)

71
Q

Live kidney donation vs Simultaneous cadaver-donor pancreas and living-donor kidney transplant

A

Live kidney donation has better results than deceased
—-> the donor and recipient can be in the same hospital, reducing warm and cold ischaemic time for the donated kidney, so better graft function

However, cadaveric simulataneous can cure diabetes
—-> so longer lasting graft, and increased 10yr survival, compared to kidney alone

SPK last longer than just pancreas because kidney rejection is more quickly identifiable, so can be resolved

72
Q

outcomes of SPK transplant

A

1 in 3 have to go back to theatre, and about 1 in 10 have major problems (removed, bleeding, thrombosis etc)

only 1 in 5 will be back on insulin in 5 years (15-20%)

and 1 in 5 will be on dialysis in 10 years (20-25%)

73
Q

DRAINAGE of the transplanted pancreas?

A

Traditionally drained into the BLADDER
—-> Lipase in urine could be measured to assess for rejection
—-> However, risk of UTIs and reflux pancreatitis

Now, attached and drained to the SMALL BOWEL (enteric drainage)

74
Q

islet cell transplantation vs pancreatic transplantation

A

no RCTs comparing them

Higher insulin independence in panc, but also higher morbidity

Islet cell transplantation in pancreatitis get their own islet cells so dont need immunosup

75
Q

Investigation for coeliac disease

A

SCREENING: serum IgA tissue transglutaminase antibody
(make sure 6weeks of gluten)

CONFIRM: Gastro referral for endoscopy and biopsy looking for duodenal villous atrophy

76
Q

Gluten containing products

A

wheat rye, and barley

77
Q

anaemia in coeliac

A

• Folate deficiency - raised MCV
• Vit B12 def
• Iron Def - low MCV

78
Q

Causes of portal hypertension

A

PREHEPATIC
• Portal vein thrombosis
• Splenic vein thrombosis
• Extrinsic compression

INTRAHEPATIC
• cirrhosis
• Primary biliary cirrhosis
• Myeloproliferative disease
• Polycystic disease
• Hepatic Mets
• Sarcoid/tb etc
• Budd chiari

POST
• thrombosis of IVC
• R sided HF
• Constrictive pericarditis
• Severe TR

79
Q

Stigmata of chronic liver disease

A

• jaundice
• encephalopathy

• clubbing
• Dupytren’s contractures
• palmar erythema
• asterixis

• spider naevi
• gynacomastia
• caput medusa

• ascites
• hepatomegaly

• would have examined for testicular atrophy

80
Q

haemochromatosis on examination

A

could be slate grey or bronze
chronic liver disease, i.e. hepatomegaly, ascites etc
venesection scars

81
Q

symptoms of haemochromatosis

A

• fatigue
• weight loss
• weakness
• joint pain
• erectile dys (Hypogonadotropic hypogonadism)
• irreg / absent periods
• ascites
• jaundice
• arrythmia
• testicular atrophy

82
Q

causes of chronic liver disease

A

3 Cs 4 Is:
• Cirrhosis (alcoholic)
• Carcinoma
• Congestion (congestive cardiac failure, budd Chiari)

• Infectious (viral hepatitis - globally most common)
• Immune (PBC, PSC, AIH)
• Inherited (Iron: haemochromatosis, Wilson’s disease, alpha 1 anti trypsin)
• Infiltrative (amyloid, myeloproliferative disorder)

83
Q

What is Budd-Chiari Syndrome

A

occlusion of the hepatic veins
classical triad of abdominal pain, ascites, and hepatomegaly

75% are primary thrombosis of the hepatic vein

25% compression of the hepatic vein by an outside structure (e.g. a tumor)

84
Q

ceruloplasmin / caeruloplasmin

A

Ceruloplasmin is a protein that is made in the liver that stores and transports copper

Test result below 10 mg/dL indicates Wilson’s disease

85
Q

ascitic tap indicating antibiotics are necessary

A

Corrected Neut ≥ 250/mm3
Culture +ve

86
Q

Importance of Thiamine in alcoholics

A

Deficiency occurs due to
• poor diet
• poor absorption due to gastritis
• high demand as it is a coenzyme in alcohol metabolism

Severe thiamine def can lead to Wernicke’s encephalopathy, (ocular motility disorders, ataxia, and confusion)

87
Q

Three symptoms of Wernicke’s encephalopathy

A

confusion, ataxia, and ocular motility disorders (nystagmus)

88
Q

How to give advice for alcoholic patients who want to change

A

FRAMES for brief intervention

• Feedback — on the person’s risk of having alcohol problems
• Responsibility — change is their responsibility
• Advice — what can be done
• Menu — and what are the options of how that can be achieved
• Empathy — an approach that is warm, reflective, and understanding
• Self-efficacy — optimism about the person’s ability to change their own behaviour

89
Q

inheritance of hereditary haemochromatosis

A

autosomal recessive

90
Q

Spontaneous bacterial peritonitis

A

Common - occurs in 25% of patients w ascites
Mortality of up to 40%

91
Q

How can you assess prognosis with cirrhosis?

A

Model for End-Stage Liver Disease (MELD) = Na, Cr, Bili, INR, and if had dialysis twice in last week

92
Q

Koilonychia

A

• can be idiopathic
• iron deficiency anemia (Plummer Vinson syndrome)
• malnutrition
• hemochromatosis
• coronary disease
• thyroid disorders

spoon-shaped

93
Q

Pros and Cons of haemo and peritoneal dialysis

A

• Peritoneal dialysis can be done from home
• fewer restrictions to diet and fluid intake

but
• done every day (rather than 3/week)
• peritonitis/hernias
• often avoided in PKD because of mechanical and infectious complications

94
Q

risks of peritoneal dialysis

A

• peritonitis
• hernias
• weight gain (your body absorbs the dextrose)
• reduced energy
• loss of proteins (significantly greater in PD than in hemodialysis)

95
Q

is a liver tranplant palpable?

A

It isn’t necessarily

If it is, it may just indicate a missmatch in donor-size, rather than any issue

96
Q

Variant syndromes for liver transplantation

A

• diuretic resistant ascites
• chronic hepatic encephalopathy
• intractable pruritus
• hepatopulmonary syndrome
• polycystic liver disease
• recurrent cholangitis.

97
Q

Indications for super-urgent liver transplantation, e.g. in paracetamol OD

A

King’s College Criteria:

• pH < 7.3, 24 hours after overdose and after fluid resuscitation

or all three of:
• INR > 6.5 (PT > 100 sec)
• Cr > 300
• grade 3–4 encephalopathy

lactate > 3.0 is strongly poor prognostic

98
Q

This man has a diagnosis of cirrhosis. Is there anything else that should be arranged for him?

A

An endoscopy, looking for:
• varices
• portal hypertensive gastropathy
• gastric antral vascular ectasia (GAVE) syndrome (blood vessels in lining of stomach become fragile / prone to rupture / bleeding)

99
Q

?cirrhosis. when do you need liver biopsy?

A

• if low albumin and derranged clotting… or if Hep C, or heavy drinkers /diagnosed ALD:

• Offer Transient elastography (FibroScan) , might give enough to diagnose cirrhosis

• Liver biopsy is gold standard, but expense, risk of complications, and restriction to secondary care. Only samples limited area so 15% false neg rate

• Needs to be transjugular if ascites

100
Q

complications of haemochromatosis

A

Liver, pancreas, heart, ant pit, joints

• Liver cirrhosis
• diabetes (type 1, due to selective beta-cell damage due to iron overload)
• iron overload cardiomyopathy
• Hypogonadotropic hypogonadism (from ant pit iron accummulation)
• athropathy
• slate grey or bronzing skin

Normal life expectancy with venesection

101
Q

Prograf

A

Aka new version of tacrilimus

102
Q

Young person with liver transplant

A

? Wilson’s

103
Q

Scoring for Cirrhosis mortality

A

Child-Pugh Score
Bili, Alb, INR, Ascites, Hepatic enceph

or MELD

104
Q

Causes of nephrotic syndrome

A

• Infection - HIV, hepatitis B + C, mycoplasma, syphilis, malaria
• Inflammatory - SLE, RA, polyarteritis nodosa, HSP, vasculitides
• Metabolic - DM, amyloidosis.
• Inherited - Sickle, Alport’s
• Malignant - multiple myeloma, leukaemia, lymphoma, breast, lung, colon, stomach
• Drugs - NSAIDs, captopril, lithium, gold, diamorphine, interferon alfa, penicillamine, probenecid etc

105
Q

Diagnosis of nephrotic syndrome

A

• Proteinuria > 3-3.5 g/24h
• or urine PCR of >300-350 mg/mmol
• Alb <25 g/l
• Peripheral oedema

total cholesterol often >10 is often present

106
Q

Extra intestinal features of IBD

A

Conjunctivitis/Uveitis/Episcleritis
Apthous ulcer
Erythema nodosum
Pyoderma granulosum (purulent ulcers with blue-black edge)
PSC
Clubbing

107
Q

Indications for splenectomy

A

• Rupture
• Haematological (ITP and hereditary spherocytosis)

108
Q

management after splenectomy

A

•  Vaccination (ideally 2/52 prior to protect against encapsulated bacteria):
⚬ Pneumococcus
⚬ Meningococcus
⚬ Haemophilus influenzae (Hib)

•  Prophylactic penicillin: (lifelong)
•  Medic alert bracelet

109
Q

four signs of decompensated liver failure

A

• Bruising/bleeding
• Jaundice
• Ascites
• Hepatic encephalopathy

110
Q

Long-term risks of Coeliac disease

A

• Malnutrition
• Malabsorption - anaemia, b12 , folate, osteoporosis
• Slightly increased risk of s. bowel cancer, s bowel lymphoma and H lymphoma
• Preg - low birth weights etc

If gluten-free for 3 - 5 years, risk is same as gen pop

111
Q

Irritable Bowel Syndrome management

A

• identify any associated stress, anxiety, and/or depression
• Good hydration, reg meals with balanced diet
• exercise

• If diarrhoea: reduce intake of insoluble fibres /any exacerbating things like caffeine alcohol
• CAn consider loperamide

• If constipated: can add Bulk-forming laxatives (fibre supplements: ispaghula) and gradually add more in

For spasms:
• Can consider mebeverine or peppermint oil
• trial of a low-dose tricyclic antidepressant

112
Q

Inherited bowel cancer

A

• Familial adenomatous polyposis (FAP) bowel cancer
• Heriditary Non-Polyposis Colorectal Cancer HNPCC (Lynch syndrome)

113
Q

Causes of pancreatitis

A

Most common are
• Alcohol
• Gallstones

Others include
• Traumatic
• Post ERCP
• Hypercalcaemia
• Hypertriglyceridemia
• Drug-related , azathioprim like steroids

Genetic causes like
• Cystic fibrosis
• PRSS1

114
Q

complications of pancreatitis

A

Acute
• Sepsis
• ARDS
• Death

Chronic
• chronic pancreatitis
• Type 3c diabetes from chronic
• portal vein thrombosis
• pseudocysts - can cause duodenal, billiary and pancreatic obstruction
—–> they can be drained by endoscopically place AXIOS stent in stomach
• Increased risk of cancer

115
Q

Management of chronic pancreatitis

A

• Avoid triggers
• Quit smoking/alcohol
• Creon - If signs of malabsorption, vit d def, hypomag, steatorrhoea
• PPI
• Good diet
• Pseudocysts can be drained by endoscopically place AXIOS stent in stomach

116
Q

Achalasia key points

A

• Failure of peristalsis of oesophagus
• and failure of the lower esophageal sphincter to relax

Management:
• nitrates and calcium channel blockers
• Balloon dilation
• Surgery - myotomy
• Botox injection

increased risk of developing esophageal cancer

117
Q

H Pylori investigation

A

• urea breath test
• stool antigen test

Can’t have had PPI for 2/52 or Abx for 4/52

118
Q

What further investigations for haemochromatosis

A

Diagnosis
• fasting transferrin saturation & ferritin
• if raised - HFE genetic testing
+- Liver biopsy rarely necessary but can assess disease severity

Complications
• HbA1c
• Cirrhosis - USS liver
• Echo - cardiomyopathy
• AFP - Hepatocellular carcinoma

119
Q

What is indomethacin?

A

NSAID

contraindicated in severe CKD

120
Q

Consequences of untreated or inadequately treated coeliac disease

A

• symptoms of coeliac

Malabsorb
• IDA
• Folate/B12
• Osteoporosis

Malnutrition

Pregnancy
• Low birth weight/premature baby

Cancer
• Rarely, increased risk of cancer of gut (Enteropathy associated T-cell lymphoma)

• Also risk of other autoimmune

Can rarely get gluten ataxia, neuropathy and enephalopathy

121
Q

Cancer associated with coeliac

A

rare, but
substantially increased risk of developing Enteropathy associated T-cell lymphoma

particularly if poorly controlled coeliac

122
Q

Nephrotic vs nephritic syndrome

A

Nephrotic
• signif proteinuria
• hypoalbuminaemia - so signif oedema
• hyperlipidaemia
• hypercoagulability

Nephritic
• Haematuria
• red cell casts in the urine
• Some proteinuria and oedema
• Hypertension

PACES (13 decks)

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