Abdo Flashcards
General inspection in abdo exam
Jaundice
Nutritional status- obese or malnourished
Exposed ideally from xiphoid to symphysis pubis
Hands in abdo exam
Clubbing
Palmar erythema
Koilonychia
Leukonychia
Dupyutrens contracture
Face and mouth in abdo exam
Jaundice
Kayser fleischer rings
Apthous ulcers
Angular stomatitis
Macroglossia
Conjunctival pallor
Xanthelasma
Chest in abdo exam
Spider naevi
Gynaecomastia
Scars for abdomen
Kochers- subcostal on right side
Midline laparotomy
Gridiron- appendicectomy
Rutherford morrison- renal transplant
Point incision scars for laparascopic ports
Subumbilical- hernia repairs
Mercedes benz- liver transplant
Causes of hepatomegaly
Alcoholic liver disease
NAFLD
Primary or secondary mets
Viral hepatitis
Sarcoid
Amyloid
Congestive heart failure
Causes of splenomegaly
Haem- CML, myelofibrosis
Infection- TB, malaria, leishmaniasis
Portal hypertension
Infilitrative- sarcoid
SLE, feltys syndrome
Causes of palpable kidneys
PCKD
Renal cysts
RCC
Amyloid
How complete abdominal exam
Hernial orifices
External genitalia
DRE
Urine dip
Full history
How examine a stoma
Assess location and attempt to define the type of stoma
Inspect skin around stoma- look for fistulas, signs of infection or parastomal hernia
What looking for in arm of abdo exam
AV fistula
Track marks
Itching
Tattoos
Laparoscopy scar differentials
Stomach- fundoplication,cardiomyotomy
Hepatobiliary procedures- cholecystectomy
Bowel procedures- appendectomy, bowel resection
Gynaecological- myomectomy, hysterectomy, oophorectomy, salpingectomy
Types of colostomy
Loop and end- ileostomy- spouted, loop will have 2 lumen
End colostomy- not spouted
RIF mass causes
Renal transplant
Ovarian cyst
Appendiceal mass
Caecal cancer
Psoas abscess
Lymphadenopathy- TB, yersinia
Ovarian cancer
Undescended testicles
LIF masses cause
Ovarian cancer/cysts
Lymphadenopathy- TB, yersinia
Abscess
Undescended testicles
Diverticulitis
Colon cancer
Psoas abscess
Renal transplant
Splenomegaly causes
Haematological conditions- CML, myelofibrosis, sequestration in SCD, lymphoma
Trauma leading to haemorrhage
Portal HTN
Infections- EBV, malaria, endocarditis, TB, leishmaniasis
Gaucher disease
Hepatomegaly causes
Malignancy- primary cancer, or benign masses, mets
Vascular- HF, budd chiari
Infiltrative- sarcoid, haemochromatosis, wilsons
Glycogen storage diseases
Infective- hepatitis viruses, malaria
Metabolic- alcohol, NAFLD
Midline laparotomy causes
Emergency surgeries- bowel obstruction, ischaemic bowel, diverticulitis, aortic aneuryms repairs, gynae procedures- ectopic and torsion
Bowel resections
Scars for appendecetomy and which one preferred plus why
Gridiron and lanz at mcburneys point
Lanz- transverse
Gridiron- oblique
Lanz preferred as better aesthetically due to continuation with langers line
What are most common causes of kidney transplant
DM
Glomerulonephritis
PCKD
HTN
Scars to look for in kidney transplant
Tesio line
AV fistula
Peritoneal dialysis
J scar
Types of kidney transplant and how long last
Live- 20-25
Donor- 15-20
Indications for kidney transplant
Acquired- DM, HTN, glomerulonephritis
- vasculitis- granulomatosis with polyangiitis, eosinophillic, microsopic
- post strep, IgA
- SLE
Inherited- alport, PCKD
Types of stoma
Ileostomy- end or loop
Colostomy- end or loop
Urostomy with ileal conduit
CKD general management
Split into preventing progression and complications and then managing complications
Conservative- low phosphate and potassium diet
Medical- statin as high IHD risk, ACEi reduces perfusion, SGLT2i prevents fibrosis
Invasive procedures once reach stage 5- dialysis and transplant
Managing complications
- bone disease
- phosphate
- anaemia
- acidosis
- hypocalcaemia
- HTN
Dialysis of complications
Short term
- hypoglycaemia
- hypotension
Longer term
- electrolyte imbalances
- fluid balance problems
- related to delivery method
Complications of AV fistula
Aneurysm
Infection
Thrombosis
Stenosis
STEAL syndrome
High-output heart failure
Main 2 complications of tunnelled cuffed catheter dialysis
On insertion
- bleeding
- pneumothorax
Longer term
- Infection
- Clots
Complications of peritoneal dialysis
Peritonitis
Weight gain
Hernias
Less effective over time
