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Medecine - As PACES > Abdo > Flashcards

Abdo Flashcards

1
Q

Blood test for the investigation of chronic liver disease

A 
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
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2
Q

Complications of chronic liver disease

A

Increased pressure: varicies, ascites
Decreased synthetic fucntion of liver: coagulapathy, encephalopathy, hypoglycaemia
Sepsis/ spontaneous bacterial perotinits
Hepatorenal syndrome

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3
Q

Child Pugh grading of cirrhosis

A 
Albumin 
Bilirubin
Clotting 
Distension - ascites 
Encephalopathy
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4
Q

Precepitants of hepatic liver disease decompensation

A 
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
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5
Q

Presentation of hepatic encephalopathy

A 
Asterixis
Ataxia 
Confusion 
Dysathria 
Constructional apraxia
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6
Q

Management of hepatic encephalopathy

A 
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
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7
Q

Poor prognostic factors in chronic liver disease

A

Worsening encephalopathy
Increased age
Decreased albumin
Increased INR

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8
Q

Cause of ascites

A

3 commonest: 3c
Cirrhosis
Congestive cardiac failure
Carcinomatosis

Serum ascites- albumin gradient
Greater or equal to 1.1 = portal HTN

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9
Q

What is portal HTN

A

Portal pressure >10mmHg

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10
Q

Indications for therepeutic paracentesis

A

Resp compromise
Pain/discomfort
Renal impairment

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11
Q

Causes of jaundice

A

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
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12
Q

Differential for a Mercedes Benz scar

A

Liver transplant
Liver segmental resection
Whipples: pacreaticduedenectomy

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13
Q

Contraindication to liver transplantion

A 
Extra-hepatic malignancy 
Severe cardiorepsitiory disease 
Systemic sepsis 
HIV infection
Non compliance with drug therapy
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14
Q

Indication for liver transplantation

A 
Recuurent variceal haemorrhage 
Intractable ascites 
SBP 
Refactory encephalopathy 
Severe jaundice 
Declining synthetic function 
Sudden detioration 
Fulminant hepatic failure
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15
Q

King’s college criteria for liver transplantation in paracetamol liver failure

A

Arterial pH 300mol

- grade III or IV encephalopathy

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16
Q

Liver edge characteristic and cause

A 
Smooth: venous congestion and fatty infiltration
Knobbly: metastase, cyst 
Pulsatile: tricuspid regurgitation 
Tender: hepatitis, RHF - capsular pain 
Bruit: HCC, AV malformation, TIPPS
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17
Q

Examination finding in heamochromatosis

A

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

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18
Q

Fucntion of the spleen

A 
Phagocytosis of old RBC/WCC 
Phagocytosis of opsonised bugs - paticualry encapsulated organs 
Ab production
Sequestration of formed blood elements 
Haematopoiesis
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19
Q

Immunisation post spleenectoy

A

Pneumovax
HIB
MEN C
Yearly flu

20
Q

Differential of enlarged kidneys

A 
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
21
Q

Triad of renal cell presentation

A

Heamaturia, loin pain, loin mass

22
Q

Paraneoplastic features of renal cell carcinoma

A 
EPO- polycythemia 
PTHrp - increased calcium 
Renin- HTN 
ACTH - Cushing syndrome 
Amyloidosis
23
Q

Contraindication to renal transplant

A

Active infection
Cancer in the proceeding 2yrs
Severe co-morbidity - paticualry cvs
Failed pre-implantation cross match

24
Q

Type of renal transplants

A

Deceased
- brain stem death with cardioveric support
- non- heart beating donar
Live - related or unrelated

25
Q

Complication of renal transplants

A

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

26
Q

Indication for renal replacement

A

GFR

27
Q

Complication of dialysis

A 
20% annual mortality 
CVD 
Malnuturiton 
Infection 
Amyloidosis 
Renal cyst- renal cell carcinoma
28
Q

Disequilibration syndrome

A

Occurs after dialysis - rapid change in plasma osmallity leads to cerebral odema

29
Q

Definition of an AV Fistula

A

Surgically created connection between atery and vien

30
Q

Complication of fistula

A 
Thrombosis 
Stenosis 
Infection 
Bleeding 
Anneyserusm
31
Q

Classification of chronic renal failure

A 
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
32
Q

Indications for acute dialysis

A

pH 7mM
Intoxicatin - digoxin or aspirin
Refractory pulmonary odema
Pericarditis or encephalopathy secondary to uraemia

33
Q

Cause of chronic renal failure

A

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

34
Q

Complications of chronic renal failure

A 
Cardiovascular disease 
Renal osteodystrophy 
Fluid - odema 
Hypertension
Electrolyte disturbance - potassium and hydrogen 
Anemia 
Legs restless 
Sensory neuropathy
35
Q

Pathological hallmark of diabetic nephropathy

A 
Glomeruloscelerosis 
Nephrons loss ( leads to HTN)
36
Q

3 ways in which rheumatoid can cause CKD

A

NSAID leading to acute tubuointersirin necrosis
Penecillamine and Gold leading to membranous GN
AA Amylodidosis in 15 %

37
Q

Nephrotic syndrome feature

A

Protienuria
Hypoalbuimiea
Odema
Hyperlipidemia

38
Q

Cause of nephrotic syndrome

A 
Primary
- minimal change disease 
- membranous glomerlous nepthropahty 
- focal segmental glomerluloscleoris 
- membranous proliferative glomerulonephritis 
Secondary - diabetes, amyloid
39
Q

Cause of nephrotic

A
  1. Proliferative/post strep glomerulonephritis
  2. 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
40
Q

True-love and witts criteria for exacerbation of IBD

A 
Syptoms
- bowel movement >6 times a day 
- large PR bleed 
Systemic signs: HR > 90 pyrexia >37.8 
Lab values: hb 30mm/HR
41
Q

Induction of UC

A
  1. 5-ASA
  2. Prednisolone
  3. Ciclosporin/ infliximab

Or topical enema

42
Q

Maintaince of UC

A
  1. 5- ASA
  2. Azothiorpine
  3. TNF inhibitors
43
Q

Chrons induction

A
  1. Ileocecal - budesonide, colitis - sulfasalazine
  2. Prednisolone
  3. Methotrexate
  4. Infliximab/adalimunmab
44
Q

Maintaince of chrons

A
  1. Azothioprine
  2. Methotrexate
  3. Infliximab
45
Q

Detention of achalasia

A

Focal motility disorder of the oseophagus caused by degeneration of the myenteric plexus of Auerbach

Medecine - As PACES (6 decks)

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