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

Abdo- medicine Flashcards by Wakana Yasuda

Causes of ascites

3 Cs:
Cirrhosis
Cardiac failure
Cancer

How well did you know this?

Not at all

Perfectly

How to determine the cause of ascites?

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

How well did you know this?

Not at all

Perfectly

Causes of portal HTN

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

How well did you know this?

Not at all

Perfectly

Conservative, medical, surgical management of ascites

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

Medical: spironolactone

Surgical: Therapeutic paracentesis

How well did you know this?

Not at all

Perfectly

Risk of paracentesis in ascites?

Major hypovolemia (must give IV albumin!)

2. Spontaneous bacterial peritonitis

How well did you know this?

Not at all

Perfectly

Mx of Spontaneous bacterial peritonitis?

Tazocin until sensitivities are known

Later: long term ciprofloxacin

How well did you know this?

Not at all

Perfectly

Causes of CKD vs causes of Renal transplant

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

How well did you know this?

Not at all

Perfectly

Features of CKD

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

How well did you know this?

Not at all

Perfectly

Indications for acute dialysis

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

How well did you know this?

Not at all

Perfectly

Management of CKD

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

How well did you know this?

Not at all

Perfectly

Renal transplants: what types of transplant are there?

what immunosuppression is given?

Types: DCD, DBD, LD

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

How well did you know this?

Not at all

Perfectly

eg of maintenance immunosuppression in renal transplant pt

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

How well did you know this?

Not at all

Perfectly

Compilations of renal transplant

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

How well did you know this?

Not at all

Perfectly

O/E findings of a pt with renal transplant

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

How well did you know this?

Not at all

Perfectly

O/E of a pt with immunosuppression from renal transplant

Gingival hypertrophy
Tacrolimus tremor
Cushingoid appearance

How well did you know this?

Not at all

Perfectly

List bare causes for CKD

DM, HTN, Glomerulonephritis, PCKD

CTD - RA, scleroderma, SLE
Amyloidosis
RAS
Myeloma
Pyelonephritis

How well did you know this?

Not at all

Perfectly

Ataxia, hallucinations, liver failure , in a young pt

wilsons

How well did you know this?

Not at all

Perfectly

Dx of wilsons

low serum caeruloplasmin

high urinary copper

How well did you know this?

Not at all

Perfectly

Liver failure
DM
Impotence
Bronzed skin

Haemochromatosis

How well did you know this?

Not at all

Perfectly

Dx of haemochromatosis

serum transferrin is high

How well did you know this?

Not at all

Perfectly

Ix in ?haemochromatosis

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

How well did you know this?

Not at all

Perfectly

Mx of haemochromatosis

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

How well did you know this?

Not at all

Perfectly

Mx of hepatic encephalopathy

Lactulose

How well did you know this?

Not at all

Perfectly

Preceding trauma + brown casts in urine

ATN following rhabdomyolysis

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

SGLT2 inhibitor | Increases urinary glucose excretion --> worsens thrush!

Mx of malaria falciparum

Stable: quinine Severe: artesunate

stages of AKI

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

Renal causes of AKI

ATN: due to ischemia or deposition of urate/IgG/myoglobin/Hb Glomerulonephritis SLE, sarcoid NSAIDs, Abx, allopurinol

Causes of hyperkalemia

CKD or AKI Addisons ACEIs Rhabdomyolysis, tumour lysis syndrome, haemolysis

Metformin + CKD?

Avoid metformin if egfr<30 --> lactic acidosis

LMWH + CKD?

avoid LMWH if eGFR<30 --> risk of bleeding

Opioid analgesia + CKD?

Avoid morphine | Opt for OXYCODON

Urgent dialysis - indications?

``` Acidosis Hyperkalemia Intoxication (aspirin, lithium, methanol) Oedema - pulmonary Uraemia (pericarditis, encephalopathy) ```

Types of renal transplant rejection

Hyper acute (hours) Acute (1-12 weeks): cell mediated. - Pain + oliguria Chronic: fibrosis and scarring of transplant vessels

Renal transplant immunosuppression?

Induction: alemtezumab + basiliximab Maintenance 1) calcineurin inhibitor (tacrolimus, ciclosporin) 2) antimetabolite (azathioprine, MMF) 3) prednisolone

Renal causes of AKI

ATN: due to ischemia or deposition of urate/IgG/myoglobin/Hb Glomerulonephritis SLE, sarcoid NSAIDs, Abx, allopurinol

Causes of hyperkalemia

CKD or AKI Addisons ACEIs Rhabdomyolysis, tumour lysis syndrome, haemolysis

Metformin + CKD?

Avoid metformin if egfr<30 --> lactic acidosis

LMWH + CKD?

avoid LMWH if eGFR<30 --> risk of bleeding

Opioid analgesia + CKD?

Avoid morphine | Opt for OXYCODON

Urgent dialysis - indications?

``` Acidosis Hyperkalemia Intoxication (aspirin, lithium, methanol) Oedema - pulmonary Uraemia (pericarditis, encephalopathy) ```

Types of renal transplant rejection

Hyper acute (hours) Acute (1-12 weeks): cell mediated. - Pain + oliguria Chronic: fibrosis and scarring of transplant vessels

Mx of Nephrotic syndrome

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

3 causes of membraneous GN

Hepatitis SLE NSAIDs

3 causes of focal segmental glomerulosclerosis

HIV DM Amyloid

mx of anti-GBM/wegeners

IV pred Immunosuppression Plasmapheresis

1st line induction treatment in UC?

5-ASA (mesalazine/sulfasalazine) +/-steroids

1st line maintenance treatment in UC?

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

1st line induction treatment in Crohns?

STEROIDS

1st line maintenance treatment in Crohns?

Azathioprine/Mercaptopurine

mx of severe exacerbation of IBD?

``` Admit IV access + ABC resus (fluids) IV hydrocortisone LMWH dietician review +/- ABx ```

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

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

Indications for surgery in UC?

Emergency: Toxic megacolon Perforation Massive haemorrhage Elective: Failure of medical Mx Malignancy FTT in children

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

``` Steatorrhoea Deficiency in Vit ADEK B12 and folate deficiency Gallstones Renal stones ```

Mx of short gut syndrome

Dietitian Supplements or TPN Loperamide

Food which coeliacs must avoid

Barley Rye Oats Wheat

Carcinoid tumours - features?

Diarrhoea Flushing Wheeze Pellagra - dermatitis, dementia, diarrhoea

Mx of carcinoid tumour

Octreotide