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PACES - Final Week Revision > Abdominal > Flashcards

Abdominal Flashcards

1
Q

Primary biliary cholangitis examination

A

Middle aged woman
Xanthelasma
Excoriation marks
Easy bruising
Hepatosplenomegaly

High ALP
Anti-mitochondrial antibody
Ursodeoxycholic acid to slow progression or liver transplant

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2
Q

Autoimmune hepatitis examination

A

Hepatomegaly, Jaundice
Vitiligo
Thyroidectomy scar
Steroid side-effects

ANA, AMA, anti-LKM antibodies
Steroids, immunosuppressants or liver transplant

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3
Q

Cause of Wilson’s disease?

A

Autosomal recessive, ATP7B gene

Reduced excretion of copper into the bile and therefore accumulation into organs such as brain, heart and liver

Causes low caeruloplasmin levels

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4
Q

Indications for urgent dialysis

A

AEIOU:
Acidosis <7.1
Electrolytes (refractory hyperkalaemia)
Ingestions (lithium, salicylates, alcohols)
Overload (congestive cardiac failure)
Uraemia (pericarditis or encephalopathy)

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5
Q

Complications of an AV fistula?

A

Infection
Thrombosis
Stenosis
Steal syndrome

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6
Q

Vascular access for RRT?

A

AV fistula
AV graft
Tunnelled venous catheter
Non-tunnelled venous catheter

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7
Q

ALWAYS present renal features of

A

Uraemia
Fluid overload
Features of renal replacement therapy

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8
Q

Causes of Nephrotic syndrome

A

FSGS
Minimal change disease
Membranous nephropathy
Membranoproliferative nephropathy

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9
Q

Symptoms of Cushing syndrome

A

Bruising, hypertension
Stretch marks, weight gain
Carpal tunnel
Proximal myopathy
Hirsutism, periods/erections

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10
Q

Causes of Cushing syndrome

A

ACTH-dependent:
- Pituitary microadenoma (MEN1)
- ectopic secretion by lung tumour
ACTH-independent:
- Adrenal adenoma or hyperplasia
- Iatrogenic from oral prednisolone

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11
Q

Investigation for Cushing syndrome

A

Confirming test:
Overnight dex suppression test or 24h urinary cortisol

Localising test: high dose dex suppression test
If ACTH and cortisol high —> CT thorax
If ACTH high and cortisol low —> MRI pituitary
If ACTH low —> CT adrenals

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12
Q

Causes of high serum-ascites albumin gradient >1.1g/l (transudate)

A

Liver cirrhosis
Congestive cardiac failure
Nephrotic syndrome
Meig’s syndrome

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13
Q

Causes of low serum-ascites albumin gradient <11.1g/l (exudate)

A

Hepatocellular carcinoma
Pancreatitis
Tuberculosis

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14
Q

Appendicectomy scar

A

McBurney’s incision

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15
Q

Liver transplant scar

A

Mercedes Benz or modified rooftop incision

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16
Q

Kidney transplant scar

A

Rutherford-Morrison incision

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17
Q

Management of Polycystic kidney disease

A

BP and lipid control
ACE inhibitor
Low salt diet
Active monitoring for kidney failure

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18
Q

Extra renal manifestations of Polycystic kidney disease

A

Hypertension
Cysts in liver/pancreas
Berry intracranial aneurysm
Mitral valve prolapse

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19
Q

Blood liver screen

A

ANA
AMA - PBC
ASMA - autoimmune hepatitis
LKM antibody - autoimmune / drug-induced hepatitis

Electrophoresis
Caeruloplasmin
Ferritin/transferrin - Haemochromatosis
AFP tumour marker

US abdomen and portal vein
Ascitic taped

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20
Q

Treatment for PBC

A

Ursodeoxycholic acid
Statins for high lipids
Oral vitamins
Calcium and biphosphonates for osteoporosis
Liver transplant

Cholestyramine or naltrexone for pruritus relief

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21
Q

Liver patient - what do you present

A
  • Peripheral signs:
    Dupuytren’s & palmar erythema
    Spider naevi, gynaecomastia
    Liver size
    Nutritional status
  • Signs of portal hypertension: splénomégalique, caput medusa
  • Evidence of décompensation: Astérixis, ascites, jaundice
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22
Q

Causes of Jaundice

A

Pre-hepatic:
- congenital red cell pathology (SCD, G6PD deficiency)
- autoimmune haemolytic anaemia
- malaria
Hepatic:
- Gilbert syndrome
- cirrhosis, cancer
- viral hepatitis
- drugs
Post-hepatic:
- biliary tree obstruction
- PBC
- PSC

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23
Q

King’s criteria for liver transplant in NON-paracetamol-induced liver failure

A

INR > 6.5
Or
Any three of the following 6:
- age >40
- not hepatitis related
- encephalopathy lasting over 7 days
- INR >3.5
- bilirubin >300

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24
Q

Symptoms of Uraemia

A

Fatigue, weight loss
Nausea, vomiting
Itching
Cognitive slowing, confusion
Frequent shallow breathing, metabolic acidosis

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25
Q

Causes of CKD

A

Diabetes
Hypertension
Glomerulonephritis
Polycystic kidney disease
Alport syndrome

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26
Q

ADPKD mutations

A

ADPKD1 on chrom 16
ADPKD2 on chrom 4

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27
Q

Differentials for unilateral palpable kidney

A

ADPKD
Renal cell carcinoma
Obstructive uropathy

28
Q

Differentials for bilateral palpable kidney

A

ADPKD
Von Hippel-Lindau syndrome
Tuberous sclerosis

29
Q

Causes of chronic liver disease

A

Alcohol
Non-alcoholic fatty liver disease
Infectious: Viral hepatitis, Malaria, CMV, EBV
Autoimmune: PBC, PSC
Metabolic: Haemochromatosis, Wilson’s disease
Cardiovascular: portal vein thrombus, congestive cardiac failure

30
Q

Signs of décompensation liver disease

A

Asterixis
Bruising
Jaundice
Distended abdomen (ascites)
Evidence of portal hypertension (splenomegaly)

31
Q

Score for severity of chronic liver disease

A

Child-Pugh score:
Bilirubin
Albumin
INR
Ascites
Encephalopathy

32
Q

Causes of hepatomegaly

A

Cancer
Cirrhosis
Cardiac failure
Infection
Immunological
Infiltrative

33
Q

Causes of Splenomegaly

A

Massive: CML, myelofibrosis, malaria, visceral leishmaniasis
Moderate: CLL, portal hypertension, Gaucher disease, Felty’s, PRV

34
Q

Causes of MASSIVE Splenomegaly

A

CML (Philadelphia chromosome)
Myelofibrosis
Malaria

35
Q

Causes of ESRF

A

Hypertension
Diabetes
Glomerulonephritides (FSGS, minimal change, membranous glomerulonephropathy)

36
Q

Causes of Adrenal insufficiency

A

Primary:
- Addison’s disease
- adrenal adenoma
- TB

Secondary:
- exogenous steroids
- pituitary adenoma

37
Q

Symptoms of Addison’s disease

A

Fatigue
Weight loss
Postural BP
Nausea/Vomiting, abdo pain, diarrhoea
Hyperpigmentation, vitiligo

38
Q

Investigations for adrenal insufficiency

A
  • Bloods (normocytic anaemia, low Na, high K, abnormal TFTs)
  • 9am cortisol (<100 indicative of adrenal insufficiency, >400 suggests fine, otherwise borderline so order short synacthen test)
  • ACTH (high if primary, low if secondary)
  • Short synacthen test (if rise to >500 after 30 mins then suggestive)
  • low aldosterone, high renin
39
Q

Management of adrenal crisis

A

Admission for:
- IV fluids
- hyperkalaemia management
- IV hydrocortisone 100mg QDS
- IV antibiotics if infection is the precipitant

40
Q

Autoimmune syndromes of which Addison’s disease can be part of?

A

Autoimmune polyglandular syndrome types 1 and 2

41
Q

Autoimmune polyglandular syndromes

A
  • type 1: chronic candidaisis, hypoparathyroidism, Addison’s, T1DM, thyroid disease
  • type 2: Addison’s, T1DM, thyroid disease
42
Q

Counselling patient on Addison’s disease

A
  • sick day rules (double dose of oral steroids if infection, emergency hydrocortisone if vomiting)
  • if strenuous exercise then ensure team mate knows to administer emergency hydrocortisone
43
Q

Tests to do on ascitic fluid

A

Microscopy, gram stain & culture
Cytology & cell count
Albumin, glucose, LDH, amylase

44
Q

Polycystic kidney disease genes

A

PKD1
PKD2

45
Q

Spleen exam

A

Can’t palpate above
Medial notch

46
Q

Kidney exam

A

Palpable upper border
Ballotable
Moves inferiority with respiration
NO NOTCH

47
Q

Management of Wilson’s disease

A

Low copper diet
Chelating agents (penicillamine)
Zinc supplements
Complications: liver failure, HCC, CKD

48
Q

Management of hereditary Haemochromatosis

A

Venesections
Monitor diabetes and cardiomyopathy

49
Q

Definition of Nephrotic syndrome

A

Proteinuria >3.5g/24h
Low albumin
High lipids
Peripheral oedema

50
Q

Management of nephrotic syndrome

A

Low sodium diet
Fluid restriction
BP control and reduce cardiovascular risk
Anticoagulation due to risk of VTE

51
Q

Complications of nephrotic syndrome

A

Increased risk of infection
VTE
CKD
increased cardiovascular risk

52
Q

Tumours in Von Hippep-Lindsay syndrome

A

Renal/Cerebellar/Spinal haemangioblastomas
Renal cell carcinoma
Phaechromocytoma
Pancreatic cancer

53
Q

Cause of abdominal pain in PKD?

A

Cyst rupture or haemorrhage
Renal stones
UTIs

54
Q

Causes of papillary necrosis

A

Pyelonephritis
Obstruction
Sickle cell disease
Tuberculosis
Cirrhosis
Aspirin nephropathy
Renal vein thrombosis
Diabetes

55
Q

Examination findings for failed transplant

A

Fluid overload
Hypertension
Tenderness over graft
Uraemic symptoms
Recently used fistula/tunnelled line

56
Q

Opportunistic infections in transplants

A

HSV (shingles)
CMV pneumonitis or retinitis
Pneumocystis jiroveci pneumonia

57
Q

Malignancies after transplant

A

Skin SCC
Lymphoma
Post transplant lymphoproliferative disease

58
Q

Management of ascites

A

Therapeutic paracentesis
Salt restricted diet
Fluid restriction
Spironolactone
Liver transplant vs TIPSS vs serial paracentesis

59
Q

Management of varices haemorrhage

A

IV fluids
IV terlipressin
IV antibiotics
Urgent OGD for banding

60
Q

Extra-hepatic manifestations of Haemochromatosis

A

Skin hyperpigmentation
Diabetes
Cardiomyopathy —> ICD and CCF
Arthritis
Hypogonadism

61
Q

Management of Haemochromatosis

A

Venesection once to twice a week
Regular US liver and AFP level due to increased risk of HCC

62
Q

Extra-hepatic manifestations of hepatitis B

A

Polyarteritis modo sa
Glomerulonephritis with nephrotic syndrome
Palpable purpura

63
Q

Management of Hepatitis B

A

Entecavir, Tenofovir
Alpha-interferon therapy

64
Q

Extra-hepatic manifestations of hepatitis C (5)

A

Diabetes
Peripheral neuropathy
Glomerulonephritis
Lymphoma
Cryoglobulinaemia

65
Q

Polycythaemia Rubra Vera management

A

Venesection to haematocrit <45%
Hydroxycarbide

66
Q

Complications of Polycythaemia Rubra Vera

A

Budd-Chiari syndrome
Strokes
Myelofibrosis
Leukaemia

PACES - Final Week Revision (7 decks)

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