Abdo Flashcards
Significant negatives in CLD
Evidence of decompensation
Evidence of SBP
Evidence of cause e.g. pigmentation, Kayser-Fleischer rings, tattoos
Spontaneous bacterial peritonitis diagnostic criteria
PMN >250mm^3
Hep C treatment
Interferon alpha + ribavirin (nucleoside inhibitor)
+/- sofosbuvir (inhibitor of viral RNA synthesis)
Treatment for PBC
Ursodeoxycholic acid
Treatment for Wilson’s disease
Penicillamine
Treatment for Hereditary Haemochromatosis
Venesection and desferrioxamine
Treatment for hepatorenal syndrome
IV albumin + terlipressin
Treatment for hepatic encephalopathy
lactulose + rifamixin
Treatment for ascites
Fluid and salt restrict, spiro, frusemide, tap, daily weights, TIPSS, transplant
Causes of chronic liver disease
Alcohol
Viral
NASH
Other: HH, AIH, drugs e.g. methotrexate/amiodarone
Complications of chronic liver disease
Decompensation / liver failure
SBP
Portal hypertension
HCC
Features of portal hypertension
Splenomegaly
Ascites
Veins: caput medusae, oesophageal varices, haemorrhoids
Features of decompensation
Jaundice, coagulopathy, ascites and hepatic encephalopthy
Treatment of SBP
Tazocin or cefotaxime and await sensitivities
Child-Pugh Grading of Cirrhosis
Albumin Bilirubin Clotting Distension (ascites) Encephalopathy
Causes of portal hypertension (portal pressure >10mmHg)
Pre-hepatic: portal vein thrombosis (e.g. in PV)
Hepatic: cirrhosis
Post-hepatic: HF, tricuspid regurg, constrictive pericarditis, Budd-Chiari
Causes of ascites
High SAAG (>1.1g/dL) = portal hypertension e.g. cirrhosis, HF, Budd-Chiari Low SAAG (>1.1g/dL) = TB, pancreatitis, infection, serositis, malignancy, nephrotic syndrome
Significant negatives in ascites
Raised JVP (not HF cause)
Periorbital oedema (not nephrotic cause)
Other evidence of decompensation (jaundice, coagulopathy, encephalopathy)
Signs of CLD e.g. clubbing, koilonychia, gynaecomastia, spider naevi
Jaundice + splenomegaly
Haemolysis
CLD –> portal HTN
Viral hepatitis e.g. EBV
Jaundice + hepatomegaly
Hepatitis
CLD
Jaundice without organomegaly or CLD
Biliary obstruction
Haemolysis
Drugs e.g. OCP, fluclox
Gilbert’s
Stigmata of immunsuppression
Cushingoid
Skin tumours e.g. AK, SCC, BCC
Gingival hypertrophy (ciclosporin)
Tremor (calcineurin inhibitors e.g. ciclosporin & tacrolimus)
Causes of hepatomegaly
Infective e.g. viral hepatitis, EBV, CMV, malaria
Congestive e.g. RHF, CCF, constrictive pericarditis, Budd-Chiari
Autoimmune
Biliary disease e.g. extrahepatic obstruction, PBC, PSC
Tumours e.g. mets, HCC, lymphoma
Haem e.g. thalassaemia, SCD
Metabolic e.g. haemochromatosis, Wilson’s
Toxins e.g. statins
Causes of splenomegaly
Myeloproliferative e.g. CML, MF Lymphoproliferative e.g. CLL, lymphoma Infective e.g. malaria, EBV, IE Haem e.g. SCD, spherocytosis Portal HTN (cirrhosis) Inflammation e.g. RA, SLE Infiltrative e.g. sarcoid and amyloid
Felty’s syndrome
Rheumatoid arthritis
Splenomegaly
Neutropenia
Function of spleen
Phagocytosis of old RBCs and WBCs Phagocytosis of opsonised bugs Antibody production Sequestration of formed blood elements Haematopoiesis
Indications for splenectomy
Trauma Rupture e.g. EBV AIHA ITP Hereditary spherocytosis Hypersplenism e.g. sequestration due to SCD or thalassaemia
Significant negatives in renal enlargement exam
Renal impairment e.g. pallor, HTN
Renal replacement therapy e.g. fistula, tunneled dialysis line or Tenchkoff catheter
Immunsuppression e.g. Cushingoid, skin tumours, gingival hypertrophy, tremor
Hydrocele secondary to RCC
Mitral valve prolapse or hepatomegaly secondary to PCKD
Causes of enlarged kidneys
Bilateral: PCKD, bilateral RCC, bialteral cysts e.g. VHL, amyloidosis, tuberous sclerosis
Unilateral: simple renal cyst, RCC
Functions of the kidney
Elimination of waste
Regulation of volume and composition of body fluid
Endocrine - EPO, renin and vit D
Autocrine function e.g. endothelin, prostaglandins, renal natriuretic peptide
Indications for renal transplant to look for on examination
DM - finger pricks, insulin marks on abdomen, lipodystrophy
PCKD - ballotable kidneys or nephrectomy scars
Connective tissue disease e.g. SLE, SS, RA
Commonest indications for renal transplant
Diabetic nephro pathy
Glomerulonephritis (idiopathic, immune e.g. SLE, infection e.g. Strep, drugs e.g. penicillamine, infiltrative e.g. amyloid)
PCKD
HTN
Immunosuppressive regimen for renal transplant
Pre-op: alemtuzumab (anti-CD52)
Post-op: short term pred, long term tacrolimus or ciclosporin
Complications of renal transplant
Post-op: bleeding, graft thrombosis, infection, urinary leaks
Rejection: hyperacute/acute/chronic
Drug toxicity: ciclosporin (nephrotoxic, gingival hypertrophy, hepatic dysfunction), tacrolimus (less nephrotoxic, diabetogenic, caridomyopathy, neurotoxicity), steroids, immunosuppresion SEs e.g. infection and malignancy
Cardiovascular disease
Complications of chronic renal failure
Cardiovascular disease Renal osteodystrophy Oedema HTN Electrolyte disturbances: hyperkalaemia, acidosis Anaemia Restless legs Sensory neuropathy
Stages of chronic renal failure
Stage 1 eGR >90 Stage 2 eGFR 60-89 Stage 3a eGFR 45-59 Stage 3b eFGR 30-44 Stage 4 eGFR 16-29 Stage 5 eGFR <15
