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PACES > Abdominal > Flashcards

Abdominal Flashcards

1
Q

Most likely causes of hepatomegaly?

3Cs, 4Is

A

Carcinoma
Cirrhosis
CCF
Immune (PBC, PSC, Hepatitis)
Infiltrative (amyloid, myeloproliferative)
Iron - haemochromatosis
Infective - viral hepatitis

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2
Q

What bloods would you want to Ix hepatomegaly?

A

FBC, U+E, LFTS
INR
Glucose
Iron studies
NI liver screen
HIV
Autoimmue
Caeruloplasmin

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3
Q

What Ix would you want for hepatomegaly?

(not bloods)

A

USS
ascitic tap
biospy
CT/MRI
Fibroscan

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4
Q

Features to support malignancy Dx?

A

Cachexia
Lymphadenopathy

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5
Q

Examination findings to suggest NASH?

A

Xanthelasma
Finger prick marks

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6
Q

Features to suggest malignant cause of hepatomegaly?

A

Nodular lower edge
Cachexia
Lymphadenopathy

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7
Q

Most useful markers of hepatic function in cirrhosis

A

Albumin
Clotting

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8
Q

AST/ALT in ALD

A

AST:ALT ratio of >2:1

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9
Q

AST/ALT in ischaemic hepatitis

A

AST:ALT ratio of >50

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10
Q

What investigations do you want in ascitic fluid

A

Corrected neutrophils
Gram stain
ZN stain
Amylase/lipase
Cytology
Albumin
Glucose

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11
Q

Whats the use of an ascitic lipase/amylase?

A

High suggests pancreatic ascites from a ductal leak

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12
Q

Whats the use of a ascitic albumin?

A

High serum:ascites albumin gradient >1.1 suggests portal hypertension
Low gradient suggests cancer, TB, pancreatitis

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13
Q

Whats the use of an ascitic glucose?

A

Low suggests infection or malignancy

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14
Q

How would you manage ALD

A

Alcohol cessation
Chlordiazepoxide/pabrinex
Nutrition
OGD ?varices (only band if hx of haemorrhage)

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15
Q

What Ix would you want to assess pancreatic function?

A

Faecal elastase
Serum albumin
Vit D
Magnesium

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16
Q

How would you manage (chronic) pancreatitis?

A

Creon
PPI

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17
Q

What ascitic fluid result indicates SBP?

A

Neutrophils >250

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18
Q

What are you looking for in an OGD to Ix cirrhosis?

A

Varices
Portal hypertensive gastropathy
GAVE

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19
Q

What ascites result shows cirrhosis?

A

SAAG (serum ascites albumin gradient) over 1.1

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20
Q

What are causes of a high SAAG?

A

Cirrhosis
Budd Chiari
Nephrotic syndrome
Meigs syndrome

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21
Q

What are causes of a low SAAG?

A

TB
Malignancy
Pancreatitis

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22
Q

How do you do a liver biopsy if someone has ascites?

A

Transjugular

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23
Q

Causes of ascites: Vascular

A

Portal hypertension
Budd Chiari
CCF
Constrictive pericarditis

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24
Q

Causes of ascites: Albumin

A

Protein losing enteropathy
Nephrotic syndrome

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25
Q

Causes of ascites: Peritoneal disease

A

Peritonitis
Meigs syndrome
Malignancy

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26
Q

Causes of ascites: Other

A

Pancreatic leak
Chylous ascites
peritoneal dialysis
Advanced hypothyroidism

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27
Q

End of bed signs of liver disease

A

Jaundice
Pigmentation
Malnourishment

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28
Q

Hand signs of liver disease

A

Dupetryns
Palmar erythema
Leukonychia
Asterixis

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29
Q

Eye signs of liver disease

A

Corneal arcus
Xanthelasma
Anaemia
Jaundice

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30
Q

How is hereditary haemochromatosis inherited?

A

Autosomal recessive
HFE gene on chromosome 6
Variable penetrance/phenotype

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31
Q

Presentation of Heriditary Haemochromatosis

A

Screening from 1st degree relative
Asymptomatic high ferritin
Arthalgia, lethargy
Sex dysfunction (pituitary/testicular deposition)
Diabetes (thirst, polyuria)
Cardiomyopathy
Bronze skin

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32
Q

Describe screening for Haemochromatosis

A

1st degree relatives
Women ferritin >200 trans sat >40%
Men ferritin >300 and 50%
Genotyping HFE

33
Q

Further Ix for sequelae Hereditary Haemochromatosis

A

HbA1c
Cirrhosis - USS liver
AFP - Hepatocellular carcinoma
Echo - cardiomyopathy
+- Liver biopsy can assess disease severity but not always necessary

34
Q

Tx of Hereditary Haemochromatosis

A

Venesect weekly ish until transferrin sat is <50% (ferritin 20-30),then maintenance

35
Q

Features of arthopathy ax with Hereditary Haemochromatosis

A

MCP
Squaring of joints
Chondrocalcinosis (differentiates from OA)
Can also cause calcium pyrophosphate deposition

36
Q

Further Bedside Ix for Herediatory Haemochromatosis examination

A

BM
Urine - sugar
ECG - AF/arrhythmias

37
Q

Imaging for Hereditary Haemochromatosis

A

USS abdo
Echo
X ray hands

38
Q

Monitoring for Hereditary Haemochromatosis (if cirrhosis)

A

AFP and USS liver every 6 months

39
Q

Lifestyle advice for Hereditary Haemochromatosis

A

Don’t drink - much worse liver disease

40
Q

How is hereditary spherocytosis inherited?

A

Autosomal dominant
Defect on one of five different genes that code proteins in RBC (usually chromosome 8)

41
Q

How does hereditary spherocytosis typically present?

A

Anaemia
Jaundice
Splenomegaly
Screening 1st degree relatives
Neonatal jaundice

42
Q

What are the complications associated with hereditary spherocytosis?

A

Aplastic crises due to infection
Anaemia (tx with serial transfusion)
Gallstones/cholecystectomy

43
Q

Bloods to diagnose Hereditary Spherocytosis?

A
  • *FBC** - reticulocyte count, Mean Corpuscular Haemoglobin MCH
  • *Blood smear** - spherocytes, haemolysis
  • *Haemolysis screen** - LDH, haptoglobin, split billirubin
  • *Coombs test** (EMA binding) or if not available osmotic fragilty test
44
Q

What treatments are available for hereditary spherocytosis?

A

Folic acid
Serial transfusions for anaemia
Mod/severe can need splenectomy
Vaccines (meningococcal, pneumo, flu)
Prophylactic ABx

45
Q

What is the mechanism of haemolysis in spherocytosis?

A

RBCs are sphere shaped rather than biconcave, then undergo haemolysis in the spleen

46
Q

Triggers of worse anaemia in Hereditary Spherocytosis

A

Infection
Infectious mononucleosis
Pregnancy

47
Q

Clinical signs of Hereditary Spherocytosis

A

Reduced pallor
Jaundice
Leg ulcers
Tenderness in RUQ (gallstones)

48
Q

What are the top 3 differentials for isolated splenomegaly?

A

CML
Myelofibrosis
Malaria

49
Q

Bloods results in Hereditary Spherocytosis

A

High - LDH, unconjugated billirubin, reticulocytes
Low/absent haptoglobin

50
Q
A

J shape scar

Renal transplant

51
Q
A

Nephrectomy scar

52
Q
A

Peritoneal dialysis

53
Q

What do you need to comment on if you find a AV fistula

A

Recent needling

If no needling and euvolaemic, can say that transplant is likely to be functioning

54
Q
A
55
Q

What follow up Ix would you want for IBD?

A

Stool sample

FBC - WCC, anaemia

Inflammatory markers

Kidney - dehydration, electrolyte imbalance

AXR

Baseline LFTs

56
Q

Management of acute IBD flare?

A

I’d start this patient on:

 Intravenous steroids

 Intravenous fluid

 Electrolyte replacement,

 I’d consider intravenous antibiotics (if I felt there was an infective element).

57
Q

Indications for surgical referral IBD?

A

I would consider surgical referral if there was:

o Any dilatation in her abdominal X-ray.

o If there is any fistulating/abscesses

o Or obstructive disease which was refractory to full medical management

58
Q

On-going management of IBD flare?

A

long term tapering course of steroids.

o add steroid sparing agent e.g Azathioprine.

o gastro ref (IBD nurse specialist follow up).

o dietician

after 10 years regular scopes?pre malignant changes

59
Q

What is coeliac disease?

A

autoimmune condition

hypersensitivity to gluten

Resulting in villous atrophy and malabsorption.

60
Q

How would you Ix coeliac?

A

: • baseline blood tests • full blood count (looking for any signs of anaemia with ferritin, B12 and folate)

  • baseline kidney function.
  • liver function tests.
  • tissue transglutamase (with immunoglobulins as well). o I would also refer the patient for an upper GI endoscopy with biopsy
61
Q

How would you manage coeliac?

A

dietician

avoid gluten.

correct nutritional deficiencies,

consider repeat biopsy in 6-months’ time to confirm villous regeneration.

62
Q

Tx for dermatits herpetiformis

A

No gluten

Dapsone

63
Q

Score for cirrhosis

A

Child Pugh A/B/C

based on billirubin/albumin/INR/ascites/encephalopathy

64
Q

Splenomegaly

+ lymphadenopathy

A

Haematological/infection

65
Q

Splenomegaly

+ signs of chronic liver disease

A

Cirrhosis with portal hypertension

66
Q

Splenomegaly

+

murmur, splinter haemorrhages

A

IE

67
Q

Splenomegaly

+

signs of rheumatoid

A

Feltys syndrome

68
Q

Indications for splenectomy

A

Rupture

ITP

Hereditary Spherocytosis

69
Q

Causes of enlarged kidneys

A

PKD

RCC

Simple cysts

Hydronephrosis

Tuberous sclerosis/amyloidosis (bilateral)

70
Q

4 signs of decompensated liver disease

A

Bruising Jaundice Ascites Encephalopathy

71
Q

Types of renal transplant

A

Live donor - relative/altruistic

Cadaveric

72
Q

Live vs Cadaveric donor

A

Live - less handling time, less ischaemic time

73
Q

How do you manage pancreatic pseudocyst

A

USS guided rain with axios stent, 6 weeks after presntation

74
Q

Clinical features of pancreatic exocrine insufficency

A
  • Steatorrhea
  • Weight loss
  • Vit D deficiency
  • Hypomagnesaemia
  • Low faecal elastase (in moderate/severe insuffiency)
75
Q

How can you tell ileostomy vs colostomy

A

Ileostomy is liquid stool

76
Q

Stoma

RIF

spouted

Semi liquid faeces

A

Ileostomy

77
Q

Indications for emergency surgery in IBD

A

Toxic megacolon

Haemorrhage

Perforation

78
Q

Possible surgeries for UC

A

Subtotal colectomy with end ileostomy

End ileostomy with mucous fistula (2 stomas, avoid leakage from rectosigmoid stump)

Protcolectomy and end ileostomy

Proctocolectomy with an ileo anal pouch reconstruction (maintains intestinal continuity, removes need for stoma, option for surgical reconstruction)

PACES (7 decks)

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