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Yr 6 PACES knowledge > Abdo- medicine > Flashcards

Abdo- medicine Flashcards

1
Q

Causes of ascites

A

3 Cs:
Cirrhosis
Cardiac failure
Cancer

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2
Q

How to determine the cause of ascites?

A

Serum Ascites Albumin Gradient
(serum - ascites)
>1.1 –> cirrhosis
<1.1 –> malignancy, pancreatitis, TB peritonitis

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3
Q

Causes of portal HTN

A

Nephrotic syndrome, PCV (pre hepatic)
Cirrhosis (hepatic)
Heart failure (post hepatic)

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4
Q

Conservative, medical, surgical management of ascites

A

Conservative: Restrict fluid + Na, monitor weight loss, stop EtOH

Medical: spironolactone

Surgical: Therapeutic paracentesis

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5
Q

Risk of paracentesis in ascites?

A
  1. Major hypovolemia (must give IV albumin!)

2. Spontaneous bacterial peritonitis

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6
Q

Mx of Spontaneous bacterial peritonitis?

A

Tazocin until sensitivities are known

Later: long term ciprofloxacin

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7
Q

Causes of CKD vs causes of Renal transplant

A

CKD: DM, HTN
Transplant: DM, Glomerulonephritis, PCKD

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8
Q

Features of CKD

A

ABCEF

  • Anemia
  • Acidosis (confusion, SOB)
  • Bone: Osteitis fibrosis cystica
  • Clearance - uraemia (confusion, periph neuropathy, restless legs, pericarditis)
  • Electrolytes - hyperkalemia (palpitations)
  • Fluid overload - pedal edema, pulmonary edema
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9
Q

Indications for acute dialysis

A

1) Acidosis <7.2
2) Hyperkalemia >7 persistently
3) Pulmonary oedema
4) Uraemia (pericarditis, encephalopathy, peripheral neuropathy)

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10
Q

Management of CKD

A

1) ACEi + statin (unless RAS)
2) Anemia –> EPO (once ACD + IDA are exc)
3) Bone –> phosphate binders, vitD3
4) K+ –> 10mL 10% calcium gluconate + 10U insulin + 100mL 20% dextrose + salbutamol nebs
5) pulm edema –> furosemide
6) restless legs –> clonazepam

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11
Q

Renal transplants: what types of transplant are there?

what immunosuppression is given?

A

Types: DCD, DBD, LD

Immunosuppression: induction + maintenance
Induction = atelezumab
Maintenance = triple therapy = Pred + antimetabolite (azathioprine) + calcineurin inhibitor (tacrolimus)

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12
Q

eg of maintenance immunosuppression in renal transplant pt

A

Prednisolone
Azathioprine (anti-metabolite)
Tacrolimus (calcineurin inhibitor)

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13
Q

Compilations of renal transplant

A

Surgical:

  • Urinary leak
  • infection
  • bleed
  • thrombosis
  • rejection (can be acute or chronic)
  • delayed graft function (in 40%)

Immunosuppression:
- malignancy - skin SCC
+ viral assoc
- Opportunistic infection: PCP, cryptococcus, Candida
- Tremor, gingival hypertrophy, bone marrow suppression

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14
Q

O/E findings of a pt with renal transplant

A

Renal transplant: Rutherford morrison scar w smooth mass + dull PN

Hands + arms:
- DM finger pricks
- (AV fistula or Tesio scar that is no longer used)
Bruising, striae, moon face –> cushingoid from immunosuppression
Face:
- Gingival hypertrophy (cyclosporin)

Abdo:
Insulin induced lipodystrophy (DM)
Huge ballot able kidneys (PCKD)
Nephrectomy scars

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15
Q

O/E of a pt with immunosuppression from renal transplant

A

Gingival hypertrophy
Tacrolimus tremor
Cushingoid appearance

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16
Q

List bare causes for CKD

A

DM, HTN, Glomerulonephritis, PCKD

CTD - RA, scleroderma, SLE
Amyloidosis
RAS
Myeloma
Pyelonephritis
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17
Q

Ataxia, hallucinations, liver failure , in a young pt

A

wilsons

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18
Q

Dx of wilsons

A

low serum caeruloplasmin

high urinary copper

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19
Q

Liver failure
DM
Impotence
Bronzed skin

A

Haemochromatosis

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20
Q

Dx of haemochromatosis

A

serum transferrin is high

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21
Q

Ix in ?haemochromatosis

A 
serum transferrin
Ferritin
LFTs, liver MRI + biopsy
Glucose (DM)
Echo, ECG (DCM)
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22
Q

Mx of haemochromatosis

A

Low iron diet + low vit C
Desferrioxamine
HepA + B vaccine

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23
Q

Mx of hepatic encephalopathy

A

Lactulose

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24
Q

Preceding trauma + brown casts in urine

A

ATN following rhabdomyolysis

25
Q

Dapaglifozin - what is it? and what condition can it aggravate?

A

SGLT2 inhibitor

Increases urinary glucose excretion –> worsens thrush!

26
Q

Mx of malaria falciparum

A

Stable: quinine
Severe: artesunate

27
Q

stages of AKI

A

1) <0.5ml/kg/h for 6 hours or Cr >1.5x baseline
2) “” for 12 hours or Cr 2-2.9x
3) <0.3 “ “ for 24 hours or 12 hrs of anuria. Cr >3x baseline

28
Q

Renal causes of AKI

A

ATN: due to ischemia or deposition of urate/IgG/myoglobin/Hb

Glomerulonephritis
SLE, sarcoid
NSAIDs, Abx, allopurinol

29
Q

Causes of hyperkalemia

A

CKD or AKI
Addisons
ACEIs

Rhabdomyolysis, tumour lysis syndrome, haemolysis

30
Q

Metformin + CKD?

A

Avoid metformin if egfr<30 –> lactic acidosis

31
Q

LMWH + CKD?

A

avoid LMWH if eGFR<30 –> risk of bleeding

32
Q

Opioid analgesia + CKD?

A

Avoid morphine

Opt for OXYCODON

33
Q

Urgent dialysis - indications?

A 
Acidosis
Hyperkalemia
Intoxication (aspirin, lithium, methanol)
Oedema - pulmonary
Uraemia (pericarditis, encephalopathy)
34
Q

Types of renal transplant rejection

A

Hyper acute (hours)

Acute (1-12 weeks): cell mediated.
- Pain + oliguria

Chronic: fibrosis and scarring of transplant vessels

35
Q

Renal transplant immunosuppression?

A

Induction: alemtezumab + basiliximab

Maintenance

1) calcineurin inhibitor (tacrolimus, ciclosporin)
2) antimetabolite (azathioprine, MMF)
3) prednisolone

36
Q

Renal causes of AKI

A

ATN: due to ischemia or deposition of urate/IgG/myoglobin/Hb

Glomerulonephritis
SLE, sarcoid
NSAIDs, Abx, allopurinol

37
Q

Causes of hyperkalemia

A

CKD or AKI
Addisons
ACEIs

Rhabdomyolysis, tumour lysis syndrome, haemolysis

38
Q

Metformin + CKD?

A

Avoid metformin if egfr<30 –> lactic acidosis

39
Q

LMWH + CKD?

A

avoid LMWH if eGFR<30 –> risk of bleeding

40
Q

Opioid analgesia + CKD?

A

Avoid morphine

Opt for OXYCODON

41
Q

Urgent dialysis - indications?

A 
Acidosis
Hyperkalemia
Intoxication (aspirin, lithium, methanol)
Oedema - pulmonary
Uraemia (pericarditis, encephalopathy)
42
Q

Types of renal transplant rejection

A

Hyper acute (hours)

Acute (1-12 weeks): cell mediated.
- Pain + oliguria

Chronic: fibrosis and scarring of transplant vessels

43
Q

Mx of Nephrotic syndrome

A 
Diuretics (furosemide)
ACEis (BP)
- prevent complications!!!
1) VTE prophylaxis
2) statin
3) Vaccination for infection
44
Q

3 causes of membraneous GN

A

Hepatitis
SLE
NSAIDs

45
Q

3 causes of focal segmental glomerulosclerosis

A

HIV
DM
Amyloid

46
Q

mx of anti-GBM/wegeners

A

IV pred
Immunosuppression
Plasmapheresis

47
Q

1st line induction treatment in UC?

A

5-ASA (mesalazine/sulfasalazine)

+/-steroids

48
Q

1st line maintenance treatment in UC?

A

5-ASA!!!!! Pr/PO (this is also used to induce remission)

49
Q

1st line induction treatment in Crohns?

A

STEROIDS

50
Q

1st line maintenance treatment in Crohns?

A

Azathioprine/Mercaptopurine

51
Q

mx of severe exacerbation of IBD?

A 
Admit
IV access + ABC resus (fluids)
IV hydrocortisone
LMWH
dietician review
\+/- ABx
52
Q

Indications for surgery in Crohns disease? Give 6 (emergency and elective)

A

Failure to respond to medical treatment
Perforation, fistula
Massive haemorrhage

Elective: Perianal disease
Rest distal bowel (loop ileostomy)
Cancer

N.B. surgery in Crohns is never curative

53
Q

Indications for surgery in UC?

A

Emergency:
Toxic megacolon
Perforation
Massive haemorrhage

Elective:
Failure of medical Mx
Malignancy
FTT in children

54
Q

Features of short gut syndrome (seen in Crohns, SI <2m)

A 
Steatorrhoea
Deficiency in Vit ADEK
B12 and folate deficiency
Gallstones
Renal stones
55
Q

Mx of short gut syndrome

A

Dietitian
Supplements or TPN
Loperamide

56
Q

Food which coeliacs must avoid

A

Barley
Rye
Oats
Wheat

57
Q

Carcinoid tumours - features?

A

Diarrhoea
Flushing
Wheeze
Pellagra - dermatitis, dementia, diarrhoea

58
Q

Mx of carcinoid tumour

A

Octreotide

Yr 6 PACES knowledge (14 decks)

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