Abdo Flashcards

1
Q

Causes / differential of jaundice

A

Pre-hepatic
- haemolytic anaemia

Hepatic
- liver failure

Post hepatic
- gallstone obstruction

Can tell apart by type of bilirubin that is high - unconjugated if pre hepatic, both in hepatic, conjugated if post hepatic. Post hepatic also has additional sx of pale stool, dark urine.

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

Causes of nail clubbing

A

Inflammatory bowel disease
Coeliac disease
GI lymphoma
Malabsorption

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

Subcostal / Kocher’s scar

Causes?

A

Cholecystectomy
Partial liver resection

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

Mercedes Benz Scar

Causes?

A

Hepatectomy?

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

Paramedian scar

Causes?

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

Lanz scar

Causes?

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

Midline laparotomy

Causes?

A

Major surgery involving whole abdomen
Emergency surgery

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

Presenting abdo exam (normal)

A

medical paraphanelia at bedside
Appeared clinically euvolemic, calm/comfortable at rest
Peripheral stigmata of disease in hands, face, neck or chest.

Closer inspection of abdomen - drain sites, stoma, scar to suggest previous surgical intervention.

Abdomen soft, non tender, no organomegaly.
Bowel sounds

Conclusion: normal abdominal examination

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

Presenting abdo exam (abnormal)

A

Paraphanelia
Volume status, patient at rest
Peripheral stigmata
Abdomen- drains, stoma, scars.
Abdomen - tender, organomegaly …

The most pertinent positive findings were ….
In keeping with a possible diagnosis of….

My other differentials would be ….. and I would like to further assess this patient by doing ……

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

Painful hepatomegaly differential

A

Substance-related:
Alcohol associated hepatitis
Toxic hepatitis - medication OD

Inflammatory:
Primary sclerosing cholangitis
Autoimmune hepatitis

Infective:
Viral hepatitis
Infectious Mononucleosis
Liver abscess

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

Painless jaundice differential

A

Prehepatic
- haemolytic anaemia

Hepatobiliary
- Pancreatic cancer
- Cholangiocarcinoma
- drug induced liver injury

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

Liver Transplant

Indications?

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

Liver Transplant

Immuosupressant therapy regimens?

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

Causes of poor wound healing?

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

Causes of splenomegaly

A

Haem:
* Chronic lymphocytic leukaemia
* Chronic myelocytic leukaemia
* Myelofibrosis

ID:
* EBV
* Infective endocarditis
* Malaria

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

Medications used in renal transplant

17
Q

Stoma types

A

Ileostomy
- liquid output
- spouted
- more often in RIF
- end = single, loop = double lumen

Colostomy
- solid output
- flush to skin
- more often in LIF
- end = single, loop = double lumen

18
Q

Types of dialysis & how they work

A

Haemodialysis
- blood removed from body, passed over membrane with dialysis fluid flowing in opposite direction, returned to body
- usually 3x/week
- access via AV fistula or central venous catheter e.g. Tesio

Peritoneal dialysis
- peritoneum forms semi permeable membrane
- (Tenckhoff) catheter inserted into peritoneum, dialysis fluid infused
- can be done at home

19
Q

Checking for patency of AV fistula

A

Palpate - thrill = patent
Auscultate - bruit = patent

Signs of infection, thrombosis

20
Q

Indications for dialysis (acute)

A

Acidosis
Electrolytes - hyperK not responsive to meds
Intoxication - with dialysable drug
Oedema
Uraemia

21
Q

Indications for renal transplant

A

Should be considered for all patients with/progressing towards G5 CKD

22
Q

Risks of renal transplant

A

From transplant
- Surgical: bleeding, infection, damage to structures
- acute rejection
- chronic rejection

From treatment
- malignancy
- atypical infections

+ Recurrence of CKD

23
Q

Stages of CKD

A

1 > 90
2 60-89
3a 45-60
3b 30-44
4 15-29
5 <15

NOTE: stage 1/2 need evidence of renal pathology e.g. proteinuria, haematuria, pathology on biopsy

24
Q

Stages of AKI

A

1: 1.5-1.9x baseline creatinine OR <0.5ml/kg/h for 6-12h
2: 2-3x baseline creatinine OR <0.5mL/kg/h for >12h
3: >3x baseline creatinine OR <0.5ml/kg/h for >24h OR Anuria for >12h

25
Issues with peritoneal dialysis
Catheter site infection Bacterial peritonitis Hernia Loss of membrane function
26
Issues with haemodialysis
Requires access e.g. formation of AV fistula Thrombosis, stenosis Infection of central catheter Dialysis disequilibrium - causes cerebral oedema, start HD slowly to avoid Hypotension Time consuming
27
Management of CKD (besides RRT)
Consider referral to nephrology Conservative - Exercise - healthy weight maintenance - smoking cessation - salt restriction To slow disease progression - ACEi, ARB - Control HbA1c e.g. metformin, dapagliflozin Complications - anaemia = iron replacement, EPO - acidosis = sodium bicarbonate - oedema = loop diuretics (high dose needed) - bone disease = dietary restriction + phosphate binders, vitamin D supplements - CVD = statin, anti-platelet (low dose aspirin) if atherosclerotic risk