ABDO AND RESP Flashcards
What are the infections that cause bronchiectasis?
TB/Pertussis/Measles
What are the Pulmonary obstructive causes of bronchiectasis?
COPD, tumour and aspiration
Name some complications of bronchiectasis
Pulmonary hypertension
Recurrent infection
Pneumothorax
Cor pulmonale
Abscess formation
Haemoptysis
Apart from MC+S what else should you culture sputum for in bronchiectasis?
Acid fast bacilli
What is an important part of management of any chronic health condition which you cant seem to remember
Vaccines
What does Azithromycin do?
Antibiotic and anti inflammatory
What type of pneumonitis occurs in IPF
UIP
What type of pneumonitis responds well to steroids
NSIP
What is the name of the clamshell scar?
Transverse thoracosternotomy
Indications for lung transplant
Bronchiectasis
CF
ILD
Pulmonary hypertension
Complications of lung transplant
Bronchiolitis obliterans
RIMS - Rejection - acute/chronic
Infection - reactivation and opportunistic
Malignancy - lymphoproliferative and skin
S- side effects of the meds - Steroids/Tacro/ciclosporin
How to manage recurrent effusion
Pleurodesis
VATS Pleurodesis
Indwelling drain and f/u in pleural clinic
What do you send pleural fluid for when you do a Tap
pH (<7.2 - empyema)
MC+S
Cytology
LDH, glucose, protein
Amylase
Triglycerides
What interacts with aminophylline causing toxic levels?
Macrolide antibiotics
What is the MRC Dyspnoea scale?
1 - no symptoms, 5 = breathless
Side effects of aminophylline toxicity?
N+V, diarrhoea, arrhythmias
Can cause low K and low phosphate
Can cause raised glucose and calcium
What are the complications of ESRF
Hyperparathyroidism
Anaemia
Fluid overload
If it was a transplant station and someone had hearing aids in, whats the condition?
Alports
What are causes of ESRF?
4 big ones - dm/htn/GN/PCKD
3 wee ones - obstructive (Check PSA)/alports/NSAIDs
What are the indications of decompensated renal disease?
Uraemia
Fluid overload
Indications for a nephrectomy in PCKD
Abdominal pain
Haemorrhage
Recurrent infections
Space for transplant
Compressive features - e..g reduced appetite/vomiting
Renal cancer
Name some complications of PBC?
Jaundice
Xanthelasma
Pain
Itch
Cirrhosis
Cholangiocarcinoma
HCC
What are some barriers/contraindications to transplant?
Active infection
Comorbidities
Raised BMI/low bmi
Causes of a raised SAAG
> 1.1g/dl
Liver - cirrhosis/fulminant liver failure/alcoholic hep
Cardiac - CCF
Schistosomiasis + SBP
Budd chiari/portal vein obstruction
Causes of low/normal saag
Nephrotic syndrome
TB
Caricomatosis peritonei
Pancreatic duct leak
What are the variant syndromes for liver transplant
DIRE
Diuretic resistant ascites
Intractable pruritus
Recurrent cholangitis
Encephalopathy
What scores are used in alcoholic hepatitis
Maddrey or glasgow
How do you decide in the chronic situation if someone is for a liver transplant?
UKELD - >49
What is the kings criteria pH score for transplant?
<7.3
How do you do a biopsy in someone with liver disease and ascites?
Via the transjugular route
What is an important investigation to do in patients with chronic liver disease?
OGD
what are the 3 main presenting symptoms of haemochromatosis
Arthralgia
Fatigue
Erectile dysfunction
What are the complications of hered sphero
Anaemia
Hypersplenism
Jaundice
Gallstones
Extramedullary haematopoiesis
Aplastic crisis - parvovirus
What is included in a haemolysis screen
HB
Blood film
Reticulocytes
Haptoglobin
LDH
Unconjug bilirubin
COOMBS - DAT
How to treat ascites
Conserv; fluid restrict, low salt
Meds; loop, spiro
Surgical; tap (if large volume needs HAS 20%), drain
TIPPS
Transplant
What causes gynaecomastia
Spironolactone
Digoxin
Chronic liver disease
Testicular tumour
Klinefelters
Kennedys
HIGH OESTROGEN STATES
Complications of acute and chronic pancreatitis
Acute - ARDS/SIRS/DEATH
Chronic - pain/malnourish/cysts/cancer/necrosis
How to determine severity of IBD
True love and witts
How to treat mild-mod crohns
Oral steroids
Oral mesalazine
How to treat mild-mod UC
Oral/rectal steroids
Oral/rectal mesalazine
How to treat severity Crohns/UC
Crohns - IVMP or IV Inflix
UC - IVMP Or IV ciclosporin
How to maintain crohsn
SAMI
Steroid
Azathioprine
Methotrexate
Inflix
How to maintain UC
SAM
Steroids
Aza
Mesalazine
On looking, how to tell the difference between an ileostomy and colostomy?
Ileostomy tends to have a spout
How to check for renal decomp?
Fluid overload
Signs of uraemia
May be active RRT in place
What signs are there of renal failure
Fistula etc
Parathyroidectomy
Anaemia
What are complications of renal fistula?
Bleeding
Infection
Aneurysm
Stenosis
Thrombosis
High output cardiac failure
How can you tell if a transplant is failing?
Fever
Abdo pain
Reduced urine output
Fluid overload
Uraemia
What are some complications of nephrotic syndrome
VTE - lose antithrombin
Infection - lose IGs
Pleural effusion - lose proteins
High lipids
What do you send in membranous nephropathy
Anti-phospholipase A2 receptor
Criteria for diagnosis of Nephrotic syndrome?
Oedema
Proteinuria (>3.5g/dl)
Hypoalbuminaemia
What are some primary causes of nephrotic syndrome
IgA nephropathy
Membranous neph
Minimal change nephropathy
FSGS
In ESRF what bloods do you send?
FBC…..
Vasculitis screen including complement
Autoimmune - ANA
Immunoglobulins/electrophoresis
PSA if obstructive
What are complications of haemodialysis
Dialysis washout (hypotension/chest pain/headache/nausea)
Infection
Gout
Bleeding
Amyloid
Extra renal manifestations of PCKD
Hepatic cysts (70%)
Berry aneurysm (10%)
Splenic cysts (5%)
MV prolapse
What are signs of uraemia?
Pruritus
Flap
Encephalopathy
N+V
Uraemic rub
If someone has ESRF and evidence of a stroke, what could have happened?
Berry aneurysm
Key points in the management of PCKD
Conservative - education/avoid nephrotoxics/3L water per day to suppress ADH
Monitor proteinuria and BP
Treat BP with ACEi
Tolvaptan
Screen for aneurysms and MVP
RRT
Differentials for enlarged kidneys
PCKD
RCC
Hydronephrosis
Tuberous sclerosis
VHL
What is VHL associated with ?
Phaeochromocytoma
Renal cell carcinoma
Cause of hepatomegaly
CCC III
ABCs
- Abscess
- Budd chiari
- Cysts
- Sickle cell disease
Signs on examination of chronic ETOH XS
Parotiditis
Dupytrens
Some blood tests to send when there is splenomegaly?
CML - philadelphia
Myelofibrosis - JAK2
Sickle cell - Hb Electrophoresis
Sarcoid - ACE
Infective - HIV/EBV/CMV
Blood film
HS - EMA Binding
Why do you check genitals when doing examination for chronic lvier disease
Testicular atrophy
How do you treat HRS
TerlipressinH
How to treat variceal bleed
ABCDE
Terlipressin
OGD + Banding
Prophylactic BB - carvedilol
TIPPS
What are the components which cause signs in liver failure
POS
Portal htn - splenomegaly/caput
Oestrogen excess- dupytrens/spider naevi/hair loss/gynaecomastia
Synthetic loss - leuconychia/bruising
Why do we check HbA1c in liver disease?
Haemochromatosis causes diabetesH
How to treat wilsons
Zinc acetate
Pencillinamine
What causes the liver to decompensate
Infection
Alcohol
Cancer
Constipation
GI bleed
Medications - Hepatotoxic
Complications of Chronic liver disease
Jaundice
encephalopathy
Varices - upper GI bleed
SBP
Acscites
Cancer
Hepato renal/pul syndrome
Causes of palmar erythema
chronic liver disease
thyrotoxicosis
pregnancy
rheumatoid arthritis
polycythaemia
Abdo causes of finger clubbing
Cirrhosis
IBD
Coeliac
Cancer
What is the criteria used for acute liver transplant
Kings
What conditions can re-occur post transplant
hepatitis B + C
PBC
What conditions can be treated with liver transplant
Cirrhosis - NASH or ALD
Cancer
PBC
Haemochrom
Wilson
AIH
Acute liver failure
