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PACES > Abdominal > Flashcards

Abdominal Flashcards

1
Q

What are the hand signs of chronic liver disease

A

Leuconychia, clubbing, dupuytren’s contracture, palmar erythema

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2
Q

What are the causes of hepatomegaly

A

Cirrhosis (alcoholic)
Carcinoma (secondaries)
Congestive cardiac failure
Infectious (HBV, HCV)
Immune (PBC, PSC, AIH)
Infiltrative (amyloid, myeloproliferative disorders)
Iron (HH)

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3
Q

What are the causes of palmar erythema

A

Cirrhosis, hyperthyroidism, pregnancy, polycythaemia, rheumatoid arthritis

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4
Q

What are the causes of gynaecomastia

A

Physiological (puberty)
Klienfelter’s
Drugs (spironolactone)
Cirrhosis
Testicular tumour/orchidectomy
Endocrine (hypo/hyperthyroid, addisons)

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5
Q

What is the Child-Pugh score based on

A

Bilirubin
Albumin
INR
Ascites
Encephalopathy

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6
Q

Which scoring system is used for assessing liver transplant

A

MELD score

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7
Q

What is the Milan criteria

A

Transplant criteria for HCC + cirrhosis:

(1) single tumor diameter less than 5 cm; (2) not more than three foci of tumor, each one not exceeding 3 cm; (3) no angioinvasion; (4) no extrahepatic involvement.

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8
Q

What are the causes of massive splenomegaly (>8cm)

A
  • haem malignancies (CML, myelofibrosis)
  • tropical infections (malaria, visceral leishmaniasis)
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9
Q

What are the causes of moderate splenomegaly (4-8cm)

A
  • myelo/lymphoproliferative disorders
  • infiltration (Gaucher’s, amyloid)
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10
Q

What are the causes of small splenomegaly (tip <4cm)

A
  • myeloproliferative
  • portal hypertension
  • infections (EBV, endocarditis, hepatitis)
  • haemolytic anaemia
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11
Q

What are the indications for splenectomy

A
  • trauma
  • haematological (ITP, hereditary spherocytosis)
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12
Q

What is important in splenectomy work up

A
  • vaccination against encapsulated bacteria (pneumococcus, meningococcus, H. Influenzae)
  • prophylactic penicillin lifelong
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13
Q

What are the causes of unilateral kidney enlargement

A
  • PKD (other kidney not palpable or contralateral nephrectomy)
  • Renal cell carcinoma
  • simple cysts
  • hydronephrosis
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14
Q

What are the causes of bilateral kidney enlargement

A
  • PKD
  • bilateral renal cell carcinoma
  • bilateral hydronephrosis
  • tuberous sclerosis
  • amyloidosis
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15
Q

What other organs are involved in ADPKD

A
  • liver (hepatic cysts)
  • intracranial berry aneurysms
  • mitral valve prolapse
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16
Q

What are the causes of gum hypertrophy

A
  • drugs: cyclosporin, phenytoin, nifedipine
  • scurvy
  • AML
  • pregnancy
  • familial
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17
Q

What skin signs may be present in transplant patients

A
  1. Malignancy
    - dysplastic changes (actinic keratosis)
    - SCC (100x increase)
    - BCC and melanoma (10x increase)
  2. Infection
    - viral warts
    - cellulitis
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18
Q

How can you assess if an AV fistula is currently working

A

Thrill
Dressings, needle marks

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19
Q

Which scar indicates renal transplant

A

Iliac fossa scar (j shaped scar)

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20
Q

What could an iliac fossa scar and a midline laparotomy scar indicate

A

Pancreas and kidney transplant (usually younger patients - may just have laparotomy and palpable transplanted kidney with no IF scar!)

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21
Q

What are the complications of steroids in transplant patients

A
  • cushingoid appearance
  • thin skin
  • abdominal striae
  • easy bruising
  • proximal myopathy
  • cataracts
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22
Q

What are the complications of cyclosporin in transplant patients

A
  • tremor
  • gingival hyperplasia
  • hypertrichosis
  • nephrotoxicity
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23
Q

What are the top 3 causes of renal transplant

A
  1. Glomerulonephritis
  2. Diabetes
  3. ADPKD
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24
Q

What is the difference between ADPKD type 1 and 2

A

Type 1: Ch 16, more severe
Type 2: Ch 4, less severe, slower progression to ESRD

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25
Q

What is the non-surgical management of ADPKD

A

Antihypertensives
Statins
Tolvaptan (V2 receptor antagonist)
High fluid, low salt diet

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26
Q

What are the indications for nephrectomy in PKD

A

Avoid if possible but indications include:
1. Make room for transplanted kidney
2. Progression to renal cell carcinoma
3. Chronic pain
4. Chronic infection
5. Large volume haematuria

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27
Q

What is the difference between corneal arcus and kayser-fleischer rings

A
  • Corneal arcus: white-grey ring from lipid deposits
  • KF rings: dark rings from copper deposits
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28
Q

What are the complications of haemochromatosis

A
  • endocrine: diabetes, testicular atrophy
  • cardiac: heart failure
  • joints: arthropathy (pseudo-gout)
  • liver: hepatomegaly, CLD
  • skin: slate-grey/bronzed appearance
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29
Q

What is the inheritance of haemochromatosis

A

AR, HFE gene on Chr 6

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30
Q

What investigations should be requested in haemochromatosis

A

Diagnosis: raised ferritin, raised transferrin sats, liver biopsy, genotyping
Complications: blood glucose, ECG/CXR/echo, Liver USS + AFP

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31
Q

What is the treatment of haemochromatosis

A
  1. Venesect 1unit/week until iron deficient, then 1 unit 3-4 times/year
  2. Avoid alcohol
  3. Surveillance for HCC
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32
Q

How do you screen for haemochromatosis in relatives

A

Iron studies (ferritin + transferrin sats) - if positive then liver biopsy and genotyping

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33
Q

What is the prognosis of haemochromatosis

A
  • If cirrhotic, reduced life expectancy and 200x risk of HCC
  • if not cirrhotic, normal life expectancy
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34
Q

What will cause hand deformities and splenomegaly

A

Felty’s disease

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35
Q

How can ADPKD present

A
  • Hypertension
  • recurrent UTIs
  • Abdo pain (bleeding/infected cyst)
  • haematuria
  • CKD
36
Q

What are the top 3 indications for liver transplant

A
  1. Cirrhosis
  2. Acute hepatic failure (Hep A, Hep B, paracetamol overdose)
  3. Hepatic malignancy (HCC)
37
Q

What is the definition of ESRF

A

GFR <15ml/min

38
Q

What are the barriers to renal transplantation

A
  • donor matching (not available)
  • malignancy
  • deep seated infection
  • ongoing vasculitis
  • severe obesity
39
Q

Which immunosuppressant causes gum hypertrophy

A

Ciclosporin

40
Q

Which immunosuppression causes tremor

A

Tacrolimus

41
Q

What tests are used to assess the livers synthetic function

A
  • INR (short term)
  • albumin (long term)
42
Q

Which liver blood test is characteristic of ALD

A

AST/ALT ratio > 2:1

43
Q

What should be considered in alcoholics with chronic abdo pain

A

Chronic pancreatitis (faecal elastase can be used to aid diagnosis)

44
Q

Which gene is affected in PKD

A

PKD1 gene (AD) - Chr 16 (85%)
PKD2 gene (AD) - Chr 4 (15%)
Infantile PKD (AR) - much less common

45
Q

Which mode of dialysis is preferred in PKD

A

HD (PD can cause discomfort and increases risk of infected cyst)

46
Q

What do most patients with PKD die from

A

Cardiac causes

47
Q

What is the management of PKD

A

Non-pharma: low salt diet, dietary protein restriction
Pharma: BP control (ACEi), statins, tolvaptan, haemodialysis
Surgical: transplant, nephrectomy if indicated

48
Q

How many spider naevi are needed to be classed as abnormal

A

> 5

49
Q

How do you examine an AV fistula

A
  • Thrill/bruit to see if it’s functioning
  • look for needling to see if it’s in use
50
Q

Which scars can indicate liver transplant

A
  • Mercedes Benz incision
  • reverse J incision
51
Q

What signs indicate portal hypertension

A

Caput medusae, splenomegaly, ascites

52
Q

What is the UK end stage liver disease score based on

A

Sodium
Creatinine
Bilirubin
INR

53
Q

What UK ELD score indicates transplant in CLD

A

> = 49

54
Q

What are the criteria for super urgent liver transplant in paracetamol overdose

A
  • pH <7.25 24hrs after OD
  • PT >100s / INR >6.5
  • Cr >300 / aneuria
  • grade 3-4 encephalopathy
55
Q

How often should AFP and liver USS be repeated in cirrhosis due to haemochromatosis

A

6 monthly

56
Q

What will joint X rays show in haemochromatosis

A

Chondrocalcinosis, squared off bone ends, hook-like osteophytes (particularly 2nd and 3rd MCP joints)

57
Q

Until when should haemochromatosis pts receive weekly transfusions

A

Until ferritin levels 20-30 and transferrin sats <50%

58
Q

How does hereditary spherocytosis usually present

A
  • Triad of anaemia, jaundice and splenomegaly
  • screening
  • neonatal jaundice
59
Q

What are the complications of hereditary spherocytosis

A
  • aplastic crisis
  • anaemia
  • gallstones
60
Q

What are the diagnostic tests for hereditary spherocytosis

A

EMA (eosine-5-maleimide) binding test (osmotic fragility test if this is not available)

61
Q

What is the management of hereditary spherocytosis

A
  • folic acid
  • transfusions
  • splenectomy (need vaccines and prophylactic antibiotics)
62
Q

Which is the most common chromosome affected in hereditary spherocytosis

A

Chromosome 8

63
Q

What are the commonest causes of cirrhosis in the UK

A
  1. Alcoholic liver disease
  2. Chronic Hep C infection
  3. NAFLD
64
Q

What criteria is used to assess severity of UC

A

Truelove Witts criteria

65
Q

What are the types of haemodialysis

A
  1. AVF
  2. Temporary CVC
  3. Tunnelled CVC
66
Q

What are the complications of an AVF

A
  1. Bleeding
  2. Failure of fistula (higher risk of synthetic)
  3. Heart failure (increased CO)
  4. Ischaemic distal limb
67
Q

What can be used to help guide which patients with ESRF need dialysis

A

The kidney failure risk equation

68
Q

What complications can occur after renal transplant

A
  1. Rejection (acute vs chronic)
  2. Infection - CMV, PCP
  3. Malignancy (skin, lymph)
  4. Immunosuppression toxicity
  5. Recurrence of original disease
  6. Chronic graft dysfunction
69
Q

When should a patient be worked up for renal transplant

A

As they approach ESRD (eGFR <15) but before they require dialysis

70
Q

Which scoring system can be used to guide need for future RRT in patients approaching ESRD

A

The kidney failure risk equation

71
Q

Which autoantibodies are positive in autoimmune hepatitis

A
  • Anti-smooth muscle
  • Anti-LKM1
  • ANA
72
Q

What UKELD score is indicative of liver transplant

A

UKELD >49

73
Q

What are the contraindications to liver transplant

A

IVDU, ongoing alcohol excess, significant co-morbidities, extensive malignancy

74
Q

How would you investigate splenomegaly

A

Diagnosis - USS abdomen
- Haem cause - FBC and blood film, JAK2, Philadelphia chromosome, CTTAP, BM biopsy, LN biopsy
- Infectious cause - thick and thin films, viral serology, HIV test
- Autoimmune cause - RF, ANA
- Haemolysis cause - LDH, haptoglobin, coombe’s test, bilirubin

75
Q

What are the complications of liver transplant

A
  1. Graft rejection (acute vs chronic)
  2. Side effects of immunosuppression
  3. Recurrence of underlying disease
76
Q

Which vein is affected in budd-chiari syndrome

A

Hepatic vein thrombosis

77
Q

What are the possible indications for a rooftop scar

A
  • liver transplant
  • liver resection
  • pancreatic surgery
  • gastric surgery
78
Q

What are the causes of liver transplant + diabetes

A
  • NAFLD
  • Haemochromatosis
  • Side effects of steroids/immunosuppression
79
Q

Which joints are most commonly affected in hereditary haemochromatosis

A

2nd and 3rd MCP and PIP joints

80
Q

What are the causes of a high SAAG gradient

A

Transudate - portal HTN

  • cirrhosis/liver failure
  • hepatic venous obstruction
  • constrictive pericarditis/CCF
  • liver metastases
81
Q

What are the causes of a low SAAG (<1.1 g/dL)

A

Exudate:

  • malignancy eg peritoneal mets
  • infection eg TB
  • pancreatitis
  • nephrotic syndrome
  • bowel obstruction/infarction
82
Q

What can cause a falsely low TTG level

A

IgA deficiency
Gluten free diet

83
Q

What is seen on jejunal biopsy in coeliac disease

A

Villous atrophy

84
Q

What are the types of kidney transplant

A

Live donor - relation/altruistic

Deceased - circulatory/neurological

85
Q

What are the advantages of simultaneous pancreas kidney transplants

A
  • better 10 year survival vs kidney transplant alone
  • no need for continuous CBG monitoring and insulin
  • glucose and lipid metabolism improved

(But unclear if long term vascular complications of diabetes improved)

PACES (6 decks)

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