ABDO AND RESP Flashcards by John Doherty

What are the infections that cause bronchiectasis?

TB/Pertussis/Measles

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What are the Pulmonary obstructive causes of bronchiectasis?

COPD, tumour and aspiration

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Name some complications of bronchiectasis

Pulmonary hypertension
Recurrent infection
Pneumothorax
Cor pulmonale
Abscess formation
Haemoptysis

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Apart from MC+S what else should you culture sputum for in bronchiectasis?

Acid fast bacilli

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What is an important part of management of any chronic health condition which you cant seem to remember

Vaccines

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What does Azithromycin do?

Antibiotic and anti inflammatory

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What type of pneumonitis occurs in IPF

UIP

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What type of pneumonitis responds well to steroids

NSIP

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What is the name of the clamshell scar?

Transverse thoracosternotomy

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Indications for lung transplant

Bronchiectasis
CF
ILD
Pulmonary hypertension

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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

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How to manage recurrent effusion

Pleurodesis
VATS Pleurodesis
Indwelling drain and f/u in pleural clinic

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What do you send pleural fluid for when you do a Tap

pH (<7.2 - empyema)
MC+S
Cytology
LDH, glucose, protein
Amylase
Triglycerides

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What interacts with aminophylline causing toxic levels?

Macrolide antibiotics

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What is the MRC Dyspnoea scale?

1 - no symptoms, 5 = breathless

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Side effects of aminophylline toxicity?

N+V, diarrhoea, arrhythmias

Can cause low K and low phosphate
Can cause raised glucose and calcium

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What are the complications of ESRF

Hyperparathyroidism
Anaemia
Fluid overload

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If it was a transplant station and someone had hearing aids in, whats the condition?

Alports

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What are causes of ESRF?

4 big ones - dm/htn/GN/PCKD
3 wee ones - obstructive (Check PSA)/alports/NSAIDs

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What are the indications of decompensated renal disease?

Uraemia
Fluid overload

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Indications for a nephrectomy in PCKD

Abdominal pain
Haemorrhage
Recurrent infections
Space for transplant
Compressive features - e..g reduced appetite/vomiting
Renal cancer

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Name some complications of PBC?

Jaundice
Xanthelasma
Pain
Itch

Cirrhosis
Cholangiocarcinoma
HCC

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What are some barriers/contraindications to transplant?

Active infection
Comorbidities
Raised BMI/low bmi

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Causes of a raised SAAG

> 1.1g/dl
Liver - cirrhosis/fulminant liver failure/alcoholic hep
Cardiac - CCF
Schistosomiasis + SBP
Budd chiari/portal vein obstruction

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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