Abdo Flashcards
Blood test for the investigation of chronic liver disease
LFT MCV HEP B & Hep C serology Lipids - NASH AutoAb: anti smooth muscle, anti-mithochondrial antibody, pANCA, ANA IG: total IgG and total IgM Genetic: caeruloplasmin, ferritin, a1AT Cancer: AFP, CA-19.9
Complications of chronic liver disease
Increased pressure: varicies, ascites
Decreased synthetic fucntion of liver: coagulapathy, encephalopathy, hypoglycaemia
Sepsis/ spontaneous bacterial perotinits
Hepatorenal syndrome
Child Pugh grading of cirrhosis
Albumin Bilirubin Clotting Distension - ascites Encephalopathy
Precepitants of hepatic liver disease decompensation
HEPATICS Heamorrhage e.g varcies Electrolyte disturbance Poisons: diuretics, sedative, anaesthesia Alcohol Tumour - hepatocellualr carcinoma Infections: SBP, pneumonia, UTI, Hep D Constipation - commonest cause Sugar/ glucose e.g. Low calorie diet
Presentation of hepatic encephalopathy
Asterixis Ataxia Confusion Dysathria Constructional apraxia
Management of hepatic encephalopathy
Nurse in a well lit calm environment Correct any preciptiants Avoid sedatives Lactulose: decreased nitrogen forming bowel bacteria, aim for 2-4 soft stools a day Rifaximin PO: kill intestinal microflora
Poor prognostic factors in chronic liver disease
Worsening encephalopathy
Increased age
Decreased albumin
Increased INR
Cause of ascites
3 commonest: 3c
Cirrhosis
Congestive cardiac failure
Carcinomatosis
Serum ascites- albumin gradient
Greater or equal to 1.1 = portal HTN
What is portal HTN
Portal pressure >10mmHg
Indications for therepeutic paracentesis
Resp compromise
Pain/discomfort
Renal impairment
Causes of jaundice
Pre- hepatic : Unconjugated
- heamolysis: autoimmune haemolytic anemia, hereditary spheroctyosis, sickle cell disease
-uncommon: PND, MAHA, malaria, G6PD
- ineffective erythropoesis e.g sickle cell disease
Hepatic
- common: chronic liver disease, alcoholic hepatitis, viral hepatitis, drugs( paracetamol, statins, anti-TB)
- rarer cause: congenital, autoimmune, cancer primary or secondary, vascular e.g. Budd chiari, decreased bilirubin excretion e.g Dublin Johson syndrome
Post- hepatic
- common: gallstone, cancer of the head of the pancreas, lymph nodes at the porta hepaptis e.g. Cancer, TB
- rarer: PBC, PSC, Cholangiocarcinoma, drugs: OCP, Augmentin and flucoxacillin
Differential for a Mercedes Benz scar
Liver transplant
Liver segmental resection
Whipples: pacreaticduedenectomy
Contraindication to liver transplantion
Extra-hepatic malignancy Severe cardiorepsitiory disease Systemic sepsis HIV infection Non compliance with drug therapy
Indication for liver transplantation
Recuurent variceal haemorrhage Intractable ascites SBP Refactory encephalopathy Severe jaundice Declining synthetic function Sudden detioration Fulminant hepatic failure
King’s college criteria for liver transplantation in paracetamol liver failure
Arterial pH 300mol
- grade III or IV encephalopathy
Liver edge characteristic and cause
Smooth: venous congestion and fatty infiltration Knobbly: metastase, cyst Pulsatile: tricuspid regurgitation Tender: hepatitis, RHF - capsular pain Bruit: HCC, AV malformation, TIPPS
Examination finding in heamochromatosis
Hepatic: hepatomegaly, cutaneous stigmata of liver disease, signs of portal HTN
MSK: athritis and joint swelling
Cardiac: dilated cardiomyopathy (SOB, Odema, raised JVP) Arrhythmia
Derm: slate grey or bronzing pigmentation ( due to melanin and iron depositon, scars in ACF (venesection), hair loss
Hypogonadism: testicular atrophy, loss of axillary and pubic hair
Hypothyroidism
Fucntion of the spleen
Phagocytosis of old RBC/WCC Phagocytosis of opsonised bugs - paticualry encapsulated organs Ab production Sequestration of formed blood elements Haematopoiesis
Immunisation post spleenectoy
Pneumovax
HIB
MEN C
Yearly flu
Differential of enlarged kidneys
Bilateral - ADPKD - bilateral renal cell carcinoma - bilateral cysts e.g Von hippel Lindau - tuberous sclerosis - Amyloidosis Unilateral - simple renal cyst - renal cell carcinoma - compensatory hypetrophy - contralatela nephrectomy
Triad of renal cell presentation
Heamaturia, loin pain, loin mass
Paraneoplastic features of renal cell carcinoma
EPO- polycythemia PTHrp - increased calcium Renin- HTN ACTH - Cushing syndrome Amyloidosis
Contraindication to renal transplant
Active infection
Cancer in the proceeding 2yrs
Severe co-morbidity - paticualry cvs
Failed pre-implantation cross match
Type of renal transplants
Deceased
- brain stem death with cardioveric support
- non- heart beating donar
Live - related or unrelated
Complication of renal transplants
Post-op: bleeding, graft thrombosis, infection, urinary leaks, hyper acute rejection
Rejection - acute or chronic
Disease reoccurrence
Drug toxicity
Increased risk of infection: CMV, pcp, funghi, warts
Increased risk of malignancy: skin and post transplant lymphoprfolivarive disease
Indication for renal replacement
GFR
Complication of dialysis
20% annual mortality CVD Malnuturiton Infection Amyloidosis Renal cyst- renal cell carcinoma
Disequilibration syndrome
Occurs after dialysis - rapid change in plasma osmallity leads to cerebral odema
Definition of an AV Fistula
Surgically created connection between atery and vien
Complication of fistula
Thrombosis Stenosis Infection Bleeding Anneyserusm
Classification of chronic renal failure
CKD 1 = eGFR >90 - but other evidence of renal damage CKD 2 = eGFR 60-90 CKD 3 = eGFR 30-59 CKD 4 = eGFR 15-29 CKD 5 = eGFR
Indications for acute dialysis
pH 7mM
Intoxicatin - digoxin or aspirin
Refractory pulmonary odema
Pericarditis or encephalopathy secondary to uraemia
Cause of chronic renal failure
Common: diabetes and HTN
Vascular: renal artery stenosis, vasculitides
Infective: pyelonephritis
Inflammatory: SLE, sarcoid, RA
Gentic: autosomal dominant polycystic kidney disease
Drugs e.g. Analgesic neuropathy
Inflitrative: myeloma, Amyloidosis
Complications of chronic renal failure
Cardiovascular disease Renal osteodystrophy Fluid - odema Hypertension Electrolyte disturbance - potassium and hydrogen Anemia Legs restless Sensory neuropathy
Pathological hallmark of diabetic nephropathy
Glomeruloscelerosis Nephrons loss ( leads to HTN)
3 ways in which rheumatoid can cause CKD
NSAID leading to acute tubuointersirin necrosis
Penecillamine and Gold leading to membranous GN
AA Amylodidosis in 15 %
Nephrotic syndrome feature
Protienuria
Hypoalbuimiea
Odema
Hyperlipidemia
Cause of nephrotic syndrome
Primary - minimal change disease - membranous glomerlous nepthropahty - focal segmental glomerluloscleoris - membranous proliferative glomerulonephritis Secondary - diabetes, amyloid
Cause of nephrotic
- Proliferative/post strep glomerulonephritis
- Cresenteric / rapidly progressive glomerluonephritis
- 3 types: 1. Type 1: Goodpastures e.g. Anti-GBM
2. Type 2: immune complex mediated - SLE, post infectious
3. IgA nepthropathy
True-love and witts criteria for exacerbation of IBD
Syptoms - bowel movement >6 times a day - large PR bleed Systemic signs: HR > 90 pyrexia >37.8 Lab values: hb 30mm/HR
Induction of UC
- 5-ASA
- Prednisolone
- Ciclosporin/ infliximab
Or topical enema
Maintaince of UC
- 5- ASA
- Azothiorpine
- TNF inhibitors
Chrons induction
- Ileocecal - budesonide, colitis - sulfasalazine
- Prednisolone
- Methotrexate
- Infliximab/adalimunmab
Maintaince of chrons
- Azothioprine
- Methotrexate
- Infliximab
Detention of achalasia
Focal motility disorder of the oseophagus caused by degeneration of the myenteric plexus of Auerbach
