Abdo Flashcards
Causes / differential of jaundice
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.
Causes of nail clubbing
Inflammatory bowel disease
Coeliac disease
GI lymphoma
Malabsorption
Subcostal / Kocher’s scar
Causes?
Cholecystectomy
Partial liver resection
Mercedes Benz Scar
Causes?
Hepatectomy?
Paramedian scar
Causes?
Lanz scar
Causes?
Midline laparotomy
Causes?
Major surgery involving whole abdomen
Emergency surgery
Presenting abdo exam (normal)
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
Presenting abdo exam (abnormal)
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 ……
Painful hepatomegaly differential
Substance-related:
Alcohol associated hepatitis
Toxic hepatitis - medication OD
Inflammatory:
Primary sclerosing cholangitis
Autoimmune hepatitis
Infective:
Viral hepatitis
Infectious Mononucleosis
Liver abscess
Painless jaundice differential
Prehepatic
- haemolytic anaemia
Hepatobiliary
- Pancreatic cancer
- Cholangiocarcinoma
- drug induced liver injury
Liver Transplant
Indications?
Liver Transplant
Immuosupressant therapy regimens?
Causes of poor wound healing?
Causes of splenomegaly
Haem:
* Chronic lymphocytic leukaemia
* Chronic myelocytic leukaemia
* Myelofibrosis
ID:
* EBV
* Infective endocarditis
* Malaria
Medications used in renal transplant
Stoma types
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
Types of dialysis & how they work
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
Checking for patency of AV fistula
Palpate - thrill = patent
Auscultate - bruit = patent
Signs of infection, thrombosis
Indications for dialysis (acute)
Acidosis
Electrolytes - hyperK not responsive to meds
Intoxication - with dialysable drug
Oedema
Uraemia
Indications for renal transplant
Should be considered for all patients with/progressing towards G5 CKD
Risks of renal transplant
From transplant
- Surgical: bleeding, infection, damage to structures
- acute rejection
- chronic rejection
From treatment
- malignancy
- atypical infections
+ Recurrence of CKD
Stages of CKD
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
Stages of AKI
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
Issues with peritoneal dialysis
Catheter site infection
Bacterial peritonitis
Hernia
Loss of membrane function
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
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
