Abdomen Flashcards
causes of bilateral renal enlargement
Polycystic kidney disease
Bilateral hydronephrosis
Bilateral renal cell carcinoma
Amyloidosis
How might patients with autosomal dominant polycystic kidney disease present?
Hypertension
Recurrent UTI
Abdominal Pain ( bleeding into cyst and cyst infection )
Abdominal/back pain
Macroscopic haematuria
familial screening
inheritance of PKD?
AD
85% ADPKD1 chromosome 16
15% ADPKD2 chromomose 4 ( later onset )
Extra renal manifestation of APKD
Hepatic cysts and hepatomegaly
Intracranial berry aneurysms
MVP
Indications for a nephrectomy polycystic kidney?
room for a transplanted kidney
Other indications : * progression to renal cell carcinoma * chronic pain * chronic infection * large and significant haematuria.
causes of unilateral enlargement
- Adult polycystic kidney disease
- Renal cell carcinoma
- Simple cysts
- Hydronephrosis
What are the causes of chronic liver disease?
ALD
NAFLD
Other important differential diagnoses include:
o auto-immune disorders, such as auto-immune hepatitis
o PBC or PSC
o hemochromatosis
o Wilson’s disease.
o alpha 1 antitrypsin deficiency
o HHT
o liver disease may also be associated with various drugs.
What are the association and complications of Primary Sclerosing cholangitis
Acute bacterial cholangitis
cholangiocarcinoma 10-20%
colorectal cancer
cirrhosis and liver failure
Biliary stricture
deficient in fat soluble vitamins
What investigations would you do in chronic liver disease ?
- blood tests: full blood count, U&Es, LFTs and a coagulation screen
- blood borne virus screening
- ferritin
- immunoglobulins and caeruloplasmin
- auto-antibody screen
- imaging- ultrasound, possibly a CT
- biopsy o non-invasive test of liver fibrosis may also be appropriate, eg a fibrotest or fibroscan.
what are the causes of hepatomegaly
- Carcinoma
- Congestion (congestive cardiac failure, Budd Chiari)
- Infectious (viral hepatitis)
- Immune (PBC, PSC, AIH)
- Infiltrative (amyloid, myeloproliferative disorder)
- Iron (haemachromatosis).
Management of ADPKD
- Strict BP control
- low-salt diet of 2 g daily
- statins.
- early tx recurrent urinary tract infections i
causes of splenomegaly
- Infiltration - myeloproliferative and lymphoproliferative disorders), lymphomas, amyloidosis, sarcoidosis, Gaucher’s disease (ie lipid storage disease), thyrotoxicosis.
- Increase function: increased removal of defective red blood cells with spherocytes, thalassaemia, nutritional anaemias and early sickle cell anaemia.
Also there is immune hyperplasia in response to infection (viral, bacterial, fungal or parasitic) including tropical splenomegaly with chronic malaria and visceral leishmaniosis i.e. Kala-azar. Also consider glandular fever, infectious hepatitis, subacute bacterial endocarditis, brucellosis and disordered immunoregulation (rheumatoid arthritis with Felty’s syndrome, SLE, sarcoidosis
3 abnormal blood flow, either with cirrhosis, or secondary to a vascular problem, such as hepatic or portal vein obstruction.
Investigations for splenomegaly
1.FBC
2. Peripheral blood film – haemolysis, morphology, malaria parasites
3.Positron emission tomography for lymphoma
4. Bone marrow aspiration and trephine
5. JAK-2 if myeloproliferative disorders suspected
4. Philadelphia chromosome if CML suspected
Autoimmune screen for RA and SLE: RF, anti-CCP, ANA
Haemolysis screen
Lactate dehydrogenase (raised)
Direct Coombs’ test (positive if immune-mediated)
Bilirubin (raised)
Haptoglobin (<30)
Consider haemoglobin electrophoresis
HIV test
Chest radiograph to look for mediastinal enlargement (lymphoma)
what are the complications of immunosuppression?
- Infections - bacterial, fungi, viral
- Skim malignancy and posttransplant lymphoproliferative disorder.
- nephrotoxicity
- hypertension
what are the indications for liver transplant ?
Cirrhosis - ALD, NAFLD, auto-immune liver disease, chronic viral hepatitis
Acute hepatic failure: Paracetamol OD, hep A and B
hepatocellular carcinoma
Investigations of haemochromatosis
Increase ferritin levels and transferrin saturations.
genetic testing - mutation in HFE gene on CH6
liber biopsy
All adult patients of Northern European ancestry with unexplained raised serum ferritin (> 300 µ/l men; > 200 µ/l women) and a random transferrin saturation (> 50% men; > 40% women)
consider
blood gluoce - HbA1c - diabetes
ECG, CXR, ECHO
Liver USS
alpa- fetoprotein - HCC
Name the scoring system that determine eligibility in patients with chronic liver disease awaiting transplant.?
UKELD- Predicts mortality in end-stage liver disease patients for transplant planning
Parameter
INR
Creatinine
Bilirubin
Sodium
UKELD, score of 49 or more.
King’s criteria for liver transplant
pH < 7.3
or
In a 24h period, all 3 of:
INR > 6 (PT > 100s) +
Cr > 300mmol/L +
grade III or IV encephalopathy
Management of haemochromatosis
- Regular venessection (1 unit/week) unti iron deficient - then venesect 1 unit 3-4 times per year
- Avoid Alcohol
- Surveillance for hCC
complications of haematochromasis
Endocrine: bronze diabetes, hypogonadism and testicular atrophy
Cardiac: congestive cardiac failure
Joints: Arthropathy ( pseudo-gout )
