Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PACES > Abdominal > Flashcards

Abdominal Flashcards

1
Q

What are the commonest causes of ESRF

A

Diabetic nephropathy, hypertension, glomerulonephritis, congenital and polycycstic kidney disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the problems following transplantation

A

Rejection- acute or chronic

chronic graft dysfunction

Immunosuppresion- infections (PCP, CMV, BK, EBV), malignancy

Increased risk of CVD, hypertension, post transplant lymphoproliferative disorder

Side effects from immunosuppression e.g. cyclosporine toxicity, prolonged steroids (osteoporosis, diabetes, cushingoid appearance)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When would you start working up a patient for a renal transplant

A

This would ideally be discussed with the patient as they approach end stage renal failure but before they require RRT as this confers a better prognosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the barriers to transplantation

A

Donor matching
active/ recent malignancy
ongoing/ recurrent infection
active vasculitis
severe obesity
contraindications to general anaesthetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the complications of transplantation in a patient with alports syndrome

A

Alports syndrome an X-linked dominant disorder characterised by a defect in the gene that codes for type IV collagen.
This results in an abnormal glomerular-basement membrane.
A new transplant can result in the formation of anti-GBM antibodies which can cause a goodpastures syndrome like picture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the differentials for a mass in the RIF

A

caecal Ca
crohns disease
ovarian tumour
ileocaecal abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

why are kidneys transplanted in the pelvis

A

good blood supply
sufficient space for the kidney
proximity to the bladder for ureteric anastamosis
easy access for biopsy/ nephrostomies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

drainage of transplanted pancreas

A

traditionally, drained into the bladder so exocrine juices (namely lipase) could be measured in the urine to monitor for graft pancreatitis/ rejection. This resulting in a higher risk of frequent UTIs, pancreatitis, metabolic acidosis (pancreatic bicarb loss) therefore it is now drained into the small bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the common causes of death in renal transplant patients

A

CVD is the commonest cause of death due to chronic inflammation, hypertension, lipids.

malignancy and infection secondary to immunosupression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the common causes of chronic liver disease

A

In the UK- the commonest cause is alcoholic liver disease and NAFLD
Other causes include: infection (viral hepatitis is the commonest cause worldwide)
metabolic causes- hereditary haemachromatosis and wilsons disease
autoimmune- autoimmune hepatitis, PBC, PSC, A1AT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the signs and causes of hepatomegaly

A

non-tender mass in the RUQ which moves with inspiration and you are unable to get above. Dull to percussion. May be smooth, craggy (malignancy) or pulsatile (CHF).

Causes of hepatomegaly
Cirrhosis
Carcinoma
CCF/ budd-chiari
Infection
Immune- PBC/ PSC/ AIH
Infiltrative
Iron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the complications of chronic liver disease

A

portal hypertension
developement of oesophageal varices which can cause catastrophic bleed
ascites- SBP
hepatic encephalopathy- due to impaired excretion of neurotoxic ammonia
hepato-renal syndrome
hepato-pulmonary syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how do you grade severity of encephalitis

A

West-Haven criteria
0- normal
1- irritability
2- confusion, inappropriate behavior
3- incoherence, restlessness
4- coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how do you grade severity of cirrhosis

A

Scoring system called the Childs-Pugh score
looks at various factors (AABCC): albumin, ascites, bilirubin, clotting (INR), confusion (encephalopathy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the causes of jaundice

A

pre-hepatic- caused by the breakdown of RBC such as in the cause of AIHA, hereditary spherocytosis, malaria

intra-hepatic- hepatocyte injury

post-hepatic- obstruction e.g. pancreatic malignancy, gall stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how do you manage ascites associated with CLD

A

maintaining a low salt diet
diuretics such as spironolactone
Drainage when causing discomfort to the patient, and when there is respiratory or cardiovascular compromise. This is performed with an ascitic drain placed temporarily with albumin cover for every 2.0–2.5 litres of ascites drained.
transjugular intrahepatic portosystemic shunt - TIPPS (increased risk of hepatic encephalopathy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the causes of gynacomastia

A

physiological: normal in puberty
syndromes with androgen deficiency: Kallman’s, Klinefelter’s
testicular failure: e.g. mumps
liver disease
testicular cancer e.g. seminoma secreting hCG
ectopic tumour secretion
hyperthyroidism
haemodialysis
drugs- spironolactone, digoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the causes of spenomegaly

A

Portal hypertension (33%) e.g. secondary to cirrhosis
haematological malignancies- CML/ myelofibrosis/lymphoproliferative disorder
infection (HIV, glandular fever)
infective endocarditis
red cell disorders- sickle- cell (can be atrophied due to multiple infarcts), thalassaemia
rheumatoid arthritis- Felty’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

causes of massive splenomegaly

A

myelofibrosis
chronic myeloid leukaemia
visceral leishmaniasis (kala-azar)
malaria
Gaucher’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

cytogenetics of CML

A

philadelphia chromosome- a translocation characterised by fusion of chromosome 9 and 22 which leads to increase in activity of tyrosine kinase

21
Q

what are the indications for a splenectomy

A

Trauma: 1/4 are iatrogenic
Spontaneous rupture: EBV
Hypersplenism: hereditary spherocytosis or elliptocytosis etc
Malignancy: lymphoma or leukaemia
Splenic cysts, hydatid cysts, splenic abscesses

22
Q

What advice would you give to a patient with hyposplenism or following a splenectomy

A

vaccinations- pneumococcal, Hib, menC
prophylactic abx- pen V, erythromycin (for at least 2 years)
malaria counselling and travel advice
carry a medic alert and bracelet
safety net to attend hospital if develops infection

23
Q

indications for liver transplant

A

Cirrhosis
hepatocellular carcinoma
acute fulminant liver failure

variant syndromes:
diuretic resistant ascites
chronic hepatic encephalopthy
intractible pruritis
polycycstic liver disease
recurrent cholangitis
hepatopulmonary syndrome

24
Q

what is acute fulminant liver

A

an acute derangement in liver function within 8 weeks from the onset of symptoms and no recognised underlying chronic liver disease

25
Q

What do you know about hereditary haemachromatosis

A

inherited autosomal recessive pattern
mutation in the HFE gene on chromosome 6
results in iron overload
suggested by transferrin saturation >60% in male, 50% in female

features
‘bronze’ skin pigmentation
diabetes mellitus
liver disease
hypogonadism (2nd to cirrhosis and pituitary dysfunction)
arthritis (especially of the hands)

26
Q

when do you consider someone for a liver transplant

A

MDT approach and have to meet criteria
UK end stage liver disease score (UKELD)- looks at INR, creatinine, bilirubin and Na

hepatocellular carcinoma- criteria on number/ diameter of tumours and risk of progression

27
Q

what are the kings criteria for liver transplantation

A

Kings criteria for liver transplant is used to assess role of liver transplantation in the context of paracetamol overdose

It is defined as:
Arterial pH < 7.3, 24 hours after ingestion

or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy

28
Q

what are contrindications to liver transplant

A

IVDU
ongoing alcohol use - abstince is mandatory in alcoholic liver disease
significant medical/ psyhiatric comorbidies that may affect survival post op
age not a factor but survival >65 much worse
prior malignancy

29
Q

UC vs CD endoscopic appearance differences

A
30
Q

why do patients have SPK

A

A combined kidney-pancreas transplant intends to cure both the patient’s diabetes and
the end stage renal failure. With the potential that the patient could then be free of haemodialysis and insulin therapy. With a reduced risk of the vascular complications of diabetes.
this was previously offered to patients with T1DM but is increasingly offered to T2DM who are insulin dependent

31
Q

What are the types of organ donation

A

Kidney transplant can either be from a live or a deceased donor.
* Live donors can be related to the patient or can be altruistic donors.
* Cadaveric donors can be donated after circulatory death or neurological death.

32
Q

causes of pancreatitis

A

alcohol
gallstone related.
trauma
endoscopic retrograde cholangiopancreatography (ERCP)
hypertriglyceridemia
hypercalcaemia
drugs (eg steroids in immunosuppressive agents).
cystic fibrosis

33
Q

complications of pancreatitis

A

Acute
systemic inflammatory response syndrome (SIRS)
respiratory failure- ARDS
death.

chronic
chronic pancreatitis
portal vein thrombosis
splenic vein thrombosis
formation of pseudocyst
This compressive effect on the pancreas causes
duodenal obstruction, biliary obstruction and
pancreatic obstruction.

34
Q

How is pseudocyst formation best drained?

A

endoscopic approach. using ultrasound-guided drainage to drain from within the gastrointestinal
tract. AXIOS stent may be used 6 weeks after presentation of pancreatitis

35
Q

clinical indicators of pancreatic exocrine insufficiency

A

steatorrhea
weight loss
vitamin D deficiency
hypomagnesemia
low faecal elastase.

36
Q

inheritance of PKD?

A

It is an autosomal dominant condition.
There are two main genetic mutations that are associated.
PKD1 (80%) mutational chromosome 16.
PKD2 (15%) mutational chromosome 4- fewer cysts, less severe, less approach ESRF
There remainder of patients have no detectable genetic abnormality.

37
Q

how to treat PCKD

A

Good control of blood pressure ideally with ACE inhibitors is very important.
There should also be aggressive control of hyperlipidaemia.
CKD is a major risk factor for ischaemic heart disease.
Patients should be on a high-fluid low-salt diet.
CKD stage 1–3 of the disease vasopressin receptor antagonist, eg tolvaptan, may
be of use.
Later in the disease, the patient may require renal replacement therapy and/or
transplant.

38
Q

extra renal manifestation of PCKD

A

hypertension
cysts in other organs, eg the liver, the pancreas and the seminal vesicles
colonic diverticulae
cardiac valve disease
abdominal or inguinal herniae.
risk of cerebral aneurysms which may present with intracerebral haemorrhage or subarachnoid haemorrhage.

  • The prevalence of aneurysms is approximately 5% in young adults increasing with
    age.
  • Prevalence can be over 20% in patients aged over 60 years.
  • Rupture on intracerebral aneurysms is associated with uncontrolled hypertension.
39
Q

indication of nephrectomy in patient with PCKD

A

make room for a transplanted kidney if a donor becomes available
progression to renal cell carcinoma
chronic pain
chronic infection
large and significant haematuria

40
Q

How might you treat someone with PBC?

A

The treatment of choice is ursodeoxycholic acid, which can relieve symptoms and also
improve prognosis.
Smoking cessation should also be advised if applicable.
if this is ineffective patient may be considered for liver transplantation

41
Q

ascitic tap- how will that help you undertand aetiology

A

Serum ascitic albumin gradient help to the underlying cause of this gentleman’s ascites.

If there was a high protein load, that would indicate that this is a more systemic cause for this man’s condition, which would be a liver cirrhosis, or from congestive cardiac failure.

If there was a low protein load, that would possibly indicate malignancy or pancreatitis or infection (tuberculous peritonitis)h

42
Q

hereditary spherocytosis presentation

A

anaemia
jaundice
splenomegaly

43
Q

What are the complications associated with hereditary spherocytosis?

A

most concerning complication is that of aplastic crises, usually due to infection.
anaemia
gallstones, which are usually treated with cholecystectomy

44
Q

how to confirm a diagnosis of hereditary spherocytosis

A

I would conduct a full blood count, focusing on the reticulocyte count and the mean corpuscular haemoglobin (MCH).

blood smear, looking for any evidence of spherocytes
or any evidence of haemolysis.

haemolysis screen, looking at the lactate dehydrogenase (LDH), haptoglobin, and split bilirubin levels

Coombs test/ osmotic fragility test.

45
Q

coeliac disease investigations

A

anti-tissue transglutaminase (TTG) antibody test
OGD with biopsy from the D2 region looking for subtotal or total villous atrophy

46
Q

signs of decompensated liver disease

A

asterixis
ascites
altered mental state (encephalopathy)- measure constructional dyspraxia; for example, ask the patient to draw a five-pointed star.

47
Q

management of ascites

A

Initially, fluid restriction and diuresis.

For ascites that is refractory to drainage, patients may be offered a TIPS procedure, a liver transplant.
What are the problems associated with TIPS in this scenario?

48
Q

signs of portal hypertension

A

Oesophageal varices or rectal varices
Ascites
Encephalopathy
Jaundice
Edema
Caput medusa

PACES (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions