Abdo Flashcards
List the triad of Sx in Budd Chari
Acute abdominal pain
Hepatomegaly
Ascites
What is Tx for Gilberts?
Reassure and discharge
Raised ALP and BR. Dx?
Cholestasis - probs due to gallstones
What is the imaging of choice for gallstones?
Abdo USS
List drugs that can cause cholestasis
Clavulanic acid Penecillin Oestrogens Erythromycin Chlorpromazine
What type of laxative is lactulose?
Osmotic
Name stimulant laxatives
Senna
Docusate sodium
Which type of laxative is indicated for intestinal obstruction?
Osmotic
What is Ispaghula husk?
Bulking agent to increase faecal mass and peristalsis
List GIT causes of clubbing
IBD Liver cirrhosis Primary biliary cirrhosis Oesophageal leiyomyoma Coeliac Achalasia
Outline Tx of upper GI bleed
Cannulate and give IV fluids
Take bloods for culture
Nil by mouth
OGD
What are the 3 most common causes of upper GI bleeds?
Peptic ulcers (50%)
Mallory Weiss tear (15%)
Oesophagitis / gastritis (5-15%)
List Mx of oesophageal varices
PRIMARY = beta blockers SECONDARY = band ligation
What causes oesophageal varices?
Portal HTN
List drugs which are known to cause liver cirrhosis
Amiodarone
Methyldopa
Methotreaxate
List signs of chronic liver disease
Leuconychia Clubbing Palmar erythema Dupuytren's contracture Spider naevi Xanthelasma Gynaecomastia Loss of body hair
How can you manage ascites?
Fluid restriction, low salt diet, diuretics
What is Tx for liver disease?
Liver transplant
What is the cause of koilonychia?
Iron deficiency anaemia
What is leuconychia?
Whitening of nails due to hypoalbuminaemia
List 2 causes of macrocytosis
Megaloblastic anaemia due to Vit B12/folate deficiency
Alcoholic liver disease
Anti-mitochondrial AB positive. Dx?
Primary biliary cirrhosis
Low copper and caeruloplasmin levels. Dx?
Wilsons disease
What is Wilsons?
Recessive disorder resulting in accumulation of copper in liver/CNS
What is haemochromatosis?
Disorder in iron metabolism
Increased intestinal absorption of iron, resulting in deposition into organs
List Sx of haemochromatosis
Asymptomatic to start
Arthralgia, tiredness, slate-grey skin pigmentation
Diabetes
How do you diagnose PSC?
MRCP
What inheritance pattern is alpha 1 antitripsin deficiecny?
Autosomal recessive
What conditions are caused by alpha 1 antitrypsin deficiency?
Emphysema, chronic liver disease, hepatocellular carcinoma, pancreatitis
Anti soluble liver angiten positive. Dx?
Autoimmune hepatitis Type 3
Anti smooth muscle ABs positive. Dx?
Autoimmune hepatitis Type 1
Which condition is associated with PSC?
UC
What 3 conditions are associated with PBC?
Thyroid disease
Systemic sclerosis
Rheumatoid arthritis
Which type of cancer are pts with PBC more susceptible to getting?
Cholangiocarcinoma
List benign liver tumours
-OMAS Haemangiomas Adenomas Fibromas Leiyomyomas
List malignant liver tumours
-COMAS / -CARCINOMAS Carcinoma Hepatoblastoma FIbrosarcomas Leiyomyosarcoma
What does a serum-ascites albumen gradient of >1.1 g/dL indicate?
Portal hypertension
List causes of portal hypertension
cirrhosis, alcoholic hepatitis, portal vein thrombosis and heart failure
What does a serum-ascites albumen gradient of <1.1 g/dL indicate?
Cancer, infections (including TB), pancreatitis and nephrotic syndrome
High alpha fetoprotein. Dx?
Hepatocellular carcinoma
High CEA. Dx?
Colorectal carcinoma
High CA 15-3. Dx?
Breast carcinoma
High HcG or CA 125. Dx?
Ovarian cancer
What is Courvoisier’s law?
Palpable gallbladder in pt with painless jaundice is unlikely to be gallstones
Triad of Sx of pancreatic cancer?
Painless jaundice, diabetes, weight loss
Ix for ?carcinoma of head of pancreas?
Abdo USS
Mucosal ulcers, inflammatory infiltrate, crypt abcesses and goblet cell depletion. Dx?
UC
Transmural, non caseataing granulomatous inflammation, fissuring ulcers, neutrophil infiltrates. Dx?
Crohns
What is classed as severe UC flare up?
Opening bowels 6+ times a day with lots of PR blood
Radiological features of Crohns?
Cobblestoning
Rose thorn ulcers
Using what medium do you get rose thorn ulcers in Corhns?
Barium follow through meal and abdo XR
What is Mx of a patient with moderate UC flare up but is systemically well?
Steroids
5-ASA (mesalazine)
Per rectum steroid foams
Mx for severe UC flare up?
Admit for IV fluids and steroids
For which IBD is smoking protective?
UC
Which part of the gut is responsible for Vit B12 absorption, and is also affected by Crohns?
Terminal ileum
Ix for iron deficiency anaemia with weight loss?
OGD and colonoscopy
Serum-ascites albumin gradient (SAAG) >1.1g/dL indicates what?
Portal hypertension
List causes of serum-ascites albumin gradient (SAAG) >1.1g/dL
cirrhosis alcoholic hepatitis portal vein thrombosis massive hepatic metastases heart failure
List causes of serum-ascites albumin gradient (SAAG) <1.1g/dL
NOT portal HTN: peritoneal carcinomatosis infection (including TB) pancreatitis nephrotic syndrome serositis (including lyphoma)