Abdomen Flashcards
Define ascities
An abnormal accumulation of fluid in the peritoneal cavity, causing abdominal swelling
Grades of ascities
Grade 1: mild, only detectable on ultrasound
Grade 2: moderate, symmetrical distension of abdomen
Grade 3: severe, gross/large ascities with marked abdominal distension
Differential for abdominal distension
Fat
Faeces
Fluid
Fetus
Fatal mass
Flatus
What would you want analysed on peritocentesis fluid?
Appearance and colour
Cells count and diff
Albumin, total protein (SAAG)
LDH
Cytology
Microscopy
Culture and gram stain
Sensitivity
ADA
Acid fast bacilli smear
Amylase
Glucose
Causes of low SAAG
<11.1
HIM
Hypoalbuminaemia (nephrotic syndrome, protein losing enteropathy, malnutrition)
Inflammatory (TB, infective peritonitis, pancreatitis)
Malignancy (pancreas, ovarian, mets)
Causes for high SAAG
> 11,1
HOLM
Heart disease (HF, constrictive pericarditis)
Obstruction of hepatic veins (Budd Chiari syndrome)
Liver disease (portal vein thrombosis, cirrhosis, fatty liver)
Massive metastasis to liver
What is liver cirrhosis
The irreversible diffuse fibrosis of the liver
Causes of hepatosplenomegaly
Chronic liver disease with portal HPT
Haematological (myeloproliferative, lymphoma, leukaemia, sickle cell, pernicious anaemia)
Infection (acute hepatitis, CMV, nfective mononucleosis)
Infiltrative (sarcoid, amyloid)
Connective tissue (SLE)
Acromegaly
Thyrotoxicosis
Complication of ascities and how do you diagnose and treat it
Spontaneous bacterial peritonitis
Diagnose: polymorph >250, protein <10 (of the ascitic fluid)
Treatment: cefotaxime 2g IVI TDS, 5-7days, albumin 1g/kg IVI
Define cirrhosis
Liver damage characterised by loss of basic architecture of the liver with fibrosis and formation of regenerative nodules
Complications of liver cirrhosis
VARICES
Varices
Ascities/anaemia
Renal failure
Infection
Coagulopathy
Encephalopathy
Sepsis
Define non-alcoholic fatty liver disease
Spectrum of disorders characterised by macrovesicular hepatic steatosis sometimes with inflammation and/or fibrosis
Define acute liver failure
An increase in transaminases, hepatic encephalopathy and impaired synthesis function with an INR >1.5 in a patient with no liver cirrhosis or pre-existing liver disease.
Causes of acute liver failure
Autoimmune
Budd chiari
Cryptococcal, CMV
Drugs and toxins
EBV
Fatty infiltration
Genetic eg Wilson’s
Hepatitis A-E, HELLP syndrome, Hypoperfusion
Infiltration (tumor)
Complications of acute liver failure
Cerebral oedema
Secondary Infections (pneumonia, sepsis, unbalanced infections)
Metabolic (hypoglycaemia, hypokalaemia, hyponatraemia, hypophosphataemia)
Multi-organ failure
Treatment of cerebral oedema secondary to acute liver failure
Lactulose 10ml tds = decrease ammonia levels
Terminate seizures = midazolam
Raised ICP = mannitol 0,5-1g/kg, monitoring for fluid overload and serum osmolality (keep <320)
Grade 3-4 encephalopathy = 30% hypertonic saline at 5-20ml/hr, maintain sodium 145-155 to reduce risk increased ICP
Management of coagulopathy in acute liver failure
Vit K IV 10mg bolus slowly
FFP’s if bleeding, preop or Intraop = 15ml/kg or 4 units
Platelets <50 and bleeding/intraop/preop = infuse platelets 10ml/kg or 6 units (check levels at 1hr and 24hrs) - survive 3-5days
Management of toxin ingestion causing Acute liver failure
Paracetamol = N-acetylcysteine
Mushroom = N-acetylcysteine and penicillin G
DILI = N-acetylcysteine
Suspected Herpes or varicella = acyclovir 5-10mg/kg every 8hrs IV
PLUS prophylactic H2 antagonists or PPI’s
Causes of splenomegaly
Congestive
Haematological
Infectious
Neoplasm
Autoimmune
Ring around eyes in Wilson’s disease
Kayser fleischer rings
Commonest causes of pancreatitis
Alcohol
Cholodocholithiasis
Idiopathic
Causes of MASSIVE splenomegaly
Chronic malaria
Chronic Schistosomiasis
Chronic TB
Primary splenic lymphoma
Myelofibrosis
Chronic myeloid leukaemia
Thalassaemia
Sarcoidosis
