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PACES > Abdominal > Flashcards

Abdominal Flashcards

1
Q

Genetic causes of PCKD

A

Mostly AD
PCKD1 - Chromosome 16 80%
PCKD2 - Chromosome 4 20% - tends to be less severe and later progression

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2
Q

Presentation of ADPCKD

A

Hypertension
Renal failure or worsening renal function
Proteinuria/haematuria
Extra renal manifestations

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3
Q

Extra renal manifestations of ADPCKD

A

Hypertension
Cysts in liver, pancreas or seminal vesicles
Cererbal aneurysms - haemorrhage
Colonic diverticuli

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4
Q

Management of PCKD

A

Management of HTN - ACEi
Hyperlipidaemia mx
High fluid low salt diet
Vasopressin antogonists eg tolvaptan may be used
RRT/dialysis

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5
Q

Indications for nephrectomy in PCKD

A

Make room for transplanted kidney
Progression to RCC
Chronic pain/infection
Large and significant haematuria

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6
Q

Clinical signs in Chronic Liver disease

A

Hepatomegaly
Spider naevi
Bruising
Corneal arcus
Loss of axillary hair
Palmar erythema
Dupytren’s contracture

Caput medusae and splenomegaly (signs of portal hypertension)

Asterixis, ascites, and jaundice - decompensation

Related to causes
- Tattoos - viral hepatitis
- Diabetes - NAFLD
- Xanthelasma - PBC

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7
Q

Causes of CLD

A

Alcoholic liver disease
Non-alcoholic fatty liver disease
Viral hepatitis
autoimmune disorders autoimmune hepatitis, PSC, PBC
Haemachromatoiss
Wilsons disease
HHT
A1AT
Drugs

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8
Q

Investigations in new CLD

A

History
FBC, U&Es, LFTs, albumin, Coag
GGT, AST
BBV
Ferritin and caeruloplasmin
Autoantibody screen - ANA, AMA, ASMA, LKM

tumour markers - AFP

CXR - if concern re CCF
USS
CT abdo/pelvis

Fibroscan

Ascitic tap if ascites

Potential endoscopy - varies, portal hypertension gastropathy
Biopsy - transjugular if ascites present

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9
Q

Antibodies in PBC

A

Elevated AMA and IgM

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10
Q

Antibodies in Autoimmune hepatitis

A

IgG, ASMA and Anti-LMK1

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11
Q

Symptoms in PBC

A

Tiredness and fatigue
Pruritis
Liver failure

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12
Q

Complications of PBC

A

CLD and cirrhosis
Malignancy - HCC

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13
Q

Treatment in PBC

A

UDCA
Liver transplant

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14
Q

Antibodies in PSC

A

pANCA

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15
Q

Common causes of ESRF

A

Diabetes
Hypertension
PCKD
Glomerulonephritis

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16
Q

When to approach renal transplantation

A

Approaching ESRF but not requiring dialysis
- better prognosis if not on dialysis

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17
Q

ESRF definition

A

eGFR <15ml/min

18
Q

Barriers/contraindications to kidney transplan

A

Not available matching donor
Malignancy
Deep seated infection
Uncontrolled vasculitis
Obesity

19
Q

Side effects of long term immunosuppression

A

Infection/malignancy particularly SCCs

Steroids - skin thinning, easy bruising, cushingnoid appearance

Cyclosporin - hirsutism, gingival hyperplasia

Tacrolimus - Tremor

20
Q

Causes of hepatomegaly

A

Alcoholic liver disease
NAFLD
Viral Hepatitis
Haemochromotosis
Malignancy
Congestive cardiac failure

21
Q

Ix of hepatomegaly

A

Bloods inc glucose and INR
Iron studies
Liver screen
HIV and BBV
USS + marking if ascites present
Ascitic tap
Fibroscan

22
Q

SAAG

A

> 1.1g/L - systemic process eg cardiac failure, portal hypertension (cirrhosis and Budd chair), nephrotic syndrome, Meig’s syndrome

<1.1g/L - Malignancy/pancreatitis/TB

23
Q

Ascitic fluid analysis

A

Albumin
Protein
Glucose
Cell count and gram stain
Amylase - pancreatitis

24
Q

Causes of CLD

A

Cirrhosis (alcoholic)
Carcinoma
Congestion - CCF and Budd-chiari

Infection - Viral hepatitis
Immune - PBC, PSC, AI
Infiltrative - Amyloid, Haemoinfiltrative disorder
Iron - Haemochromotosis

25
Q

Liver function indicative of alcoholic hepatitis

A

AST:ALT ration >2

26
Q

Identification of chronic pancreatitis - hx of abdominal pain in alcoholic liver disease

A

Faecal elastase
Mg - Low
Serum albumin - low indicates poor prognosis
Vitamin D - Low

27
Q

Why is peritoneal dialysis avoided in ADPCKD

A

Large volume of fluid required in PD with large kidneys
Increased risk of cyst infection

28
Q

Causes of splenomegaly

A

Portal hypertension

Haemotological disorders
- Lymphoma and lymphatic leukaemia
Myeloproliferative diapers, polycythaemia rubra ver and myelofibrosis
- Haemolytic anaemia and congenital spherocytosis, sickle cell

Infections
- Glandular fever
- Malaria
- Leishmaniasis
- Brucellosis
- TB
- Subacute endocarditis

Rheumatological:
- Feltys syndrome
- SLE

Sarcoidosis
Amyloidosis
Thyrotoxicosis
Gauchers disease

29
Q

Ix

A

Bloods
Autoimmune screen
HIV screen
USS abdo
Thick and thin films
Blood films
DAT

CTTAP - ?lymphoma

Bone marrow biopsy and trephine

30
Q

Causes of massive splenomegaly

A

Myelofibrosis
Myeloid leukaemia
Malarai
Kal Azar

31
Q

Causes of hepatosplenomegaly

A

Lymphoma
Myeloproliferative diseases
Cirrhosis with portal hypertension
Amyloidosis
Sarcoidosis
Glycogen storage disease

32
Q

Tests in hereditary spherocytosis

A

Blood film
Osmotic fragility test
Flow cytometry
Increased reticulocytes

33
Q

Complications of immunosuppression

A

Infection
Skin malignancy
Seborrhoic warts/actinic keratoses
Hypertension
Nephrotoxicity

34
Q

Indications for liver transplant

A

Haemochromatosis
Drug induced liver injury - paracetamol
Alcoholic liver disease - in abstinent patients
NAFLD
Autoimmune - AI, PBC or PSC
Chronic viral hepatitis
HCC
Wilsons disease
A1AT

Variant syndromes - diuretic resistant ascites, chronic hepateencephalopaty, intractable pruritus, hepatopulmonary syndrome, recurrent cholangitis

35
Q

Suitability for liver transplant

A

Significant liver dysfunction
MDT approach
UK model for end stage liver disease (UKELD)

36
Q

Ix of haemochromatosis

A

Routine blood
Ferritin
Transferrin saturations
Genetic testing - mutations in HFE gene

37
Q

Immunosuppression side effects

A

Steroids
- Insulin injection sites/glucose testing
- Striae
- Cushinghoid face

Tacrolimus
- Tremor

Ciclosporin
- Gum hypertrophy

38
Q

Contraindications to liver transplant

A

IV drug abuse
Alcohol excess - abstinence mandatory for ALD
Significant medical or psychiatric issues
History of prior malignancy
Age not a contraindication but poorer outcomes >65

39
Q

UKELD score

A

> 49 - suitable for transplant

NA
Creatinine
INR
Bilirubin

40
Q

Indications for liver transplant following paracetamol overdose

A

pH 7.25 24hrs post OD with adequate fluid resuscitation

OR

Creat>300
PT >100s
Grae 3/4 encephalopathy

41
Q

Complications of liver transplant

A

Acute or chronic rejection
Biliary leaks and strictures
Immunosuppression side effects
Metabolic syndrome
Avoid live vaccines
Recurrence of hepatic disease e.g. PBC, viral hepatitis or Budd-Chiari syndrome

42
Q

Causes of ascites

A

Vascular:
- Portal hypetension
- Budd chiari
- CCF
- Restrictive pericarditis

Low albumin
- Nephropathy
- Protein losing enteropathy

Peritoneal disease
- Meigs syndrome
- Infectious pertonitis - TB or fungal disease
- Malignancy - ovarian/gastro-intestinal

Miscellaneous
- Pancreatic leak
- Chylous ascites
- Peritoneal dialysis related ascites
- Advanced hypothyroidism

PACES (6 decks)

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