Abdominal Flashcards

1
Q

What are the causes of end-stage renal failure?

A

Common causes:
- Diabetes mellitus
- Glomerulonephritis
- Hypertension

Rarer causes:
- Hereditary renal diseases (e.g. ADPKD)
- Renovascular disease
- Chronic obstruction/interstitial nephritis

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

What are the barriers to renal transplantation (including contraindications)?

A

Barriers:
- Donor matching
- Organ availability
- Availability of support

Contraindications:
- Active/recent malignancy
- Active deep-seated infection
- Active vasculitis
- Severe obesity

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

What are the causes of ascites?

A
  • Chronic liver disease (most common)
  • Congestive heart failure
  • Malignancy
  • Pancreatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the commonly requested lab tests for an ascitic tap?

A
  • Cell count (neutrophil >250 mm^3 suggests SBP)
  • Gram stain
  • Albumin (SAAG >1.1g/dL suggests systemic cause of ascites such as heart failure and chronic liver disease)
  • Amylase/lypase (elvated levels suggests pancreatitis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the indications for nephrectomy in ADPKD?

A
  • Recurrent UTIs
  • Chronic pain
  • RCC
  • Debulking for symtpom control or in preparation for transplantation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the causes of mild-moderate splenomegaly?

A

Infiltrative:
- Lympho-/myeloproliferative diseases
- Lymphomas
- Amyloidosis
- Sarcoidosis
- Gaucher’s disease
- Thyrotoxicosis

Increased function:
Red blood cell removal
- Hereditary spherocytosis
- Thalassaemias
- Sickle cell anaemia

Immune hyperplasia
- Chronic malaria
- Kala-azar (visceral leishmaniasis)
- Glandular fever
- Infective hepatitis
- Subacute bacterial endocarditis
- Brucellosis

Disordered immunoregulation
- RA + Felty’s syndrome
- SLE
- Sarcoidosis

Abnormal blood flow
- Portal hypertension
- Hepatic/portal vein thrombosis

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

What are the causes of massive splenomegaly?

A
  • CML
  • Myelofibrosis
  • Gaucher’s disease
  • Chronic malaria
  • Kala-azar (visceral leishmaniasis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the irreversible signs of chronic liver disease even following liver transplantation?

A
  • Gynaecomastia
  • Dupuytren’s contractures
  • Spenomegaly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the indications for liver transplantation?

A

Main indications:
- Liver cirrhosis due to chronic liver disease
- HCC
- Acute liver failure

Other variant syndromes:
- Diuretic-resistant ascites
- Chronic hepatic encephalopathy
- Intractable pruritus
- Hepatopulmonary syndrome
- Polycystic liver disease
- Recurrent cholangitis

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

What are the main contraindications to liver transplantation?

A
  • Drug abuse
  • Ongoing alcohol abuse (especially if indication for transplantaiton is alcohol-related liver disease)
  • Significant medical comorbidities
  • Significant psychiatric comorbidities
  • Age (not absolute contraindication but survivial rates for transplantation >65yrs old is significantly lower)
  • Active malignancy
  • History of malignancy (not absolute but recurrence rates will need to be taken into account)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the main complications associated with liver transplantation?

A

Graft:
- Acute/chronic rejection
- Recurrence of primary liver disease

Immunosuppression:
- Infections (bacterial, viral, fungal)
- Malignancy (especially skin malignancies)
- Metabolic syndrome (hypertension, diabetes, dyslipidaemia)

Biliary:
- Biliary leak
- Biliary strictures

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

What is the King’s College criteria for emergency liver transplantation in acute paracetamol overndose?

A

pH <7.3

or in 24hrs period:

  • INR >6 &
  • Creat >300mmol/L &
  • Grade III - IV encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the causes of ascites?

A

Vasular:
- Portal hypertension
- Budd-Chiari
- Congestive heart failure
- Constrictive pericarditis

Hypoalbuminaemia:
- Nephrotic syndrome
- Protein-losing enteropathy

Peritoneal disease:
- Meig’s syndrome
- Infectious peritonitis (TB, fungal)
- Malignancy

Other:
- Pancreatitis
- Chyle leak
- Peritoneal dialysis
- Hypothyroidism

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

What are the causes of high SAAG (>1.1 g/L) ascites?

A
  • Portal hypertension
  • Congestive heart failure
  • Nephrotic syndrome
  • Budd-Chairi
  • Meig’s syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the causes of low SAAG (<1.1 g/L) ascites?

A
  • Malignancy
  • Infectious peritonitis
  • Pancreatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the threshold for screening individuals for hereditary haemochromatosis?

A
  1. 1st degree relative with diagnosis of haemochromatosis
  2. All adult patients of Northern European ancestry with unexplained raised serum ferritin
    (> 300 µ/l men; > 200 µ/l women) and a random transferrin saturation (> 50% men; >
    40% women) and normal full blood count
17
Q

What are the benefits of SPK in patients with type 1 diabetes?

A
  • Reduced mortality
  • Improved quality of life without need for insulin administration or frequent BM monitoring
  • Improved glycaemic control
  • Prevention/partial reversal of long-term complications of diabetes (inlcuding cardiovascular, nephropathy and neuropathy; evidence unclear for retinopathy)
18
Q

What are the causes of gynaecomastia?

A
  • Physiological (puberty)
  • Chronic liver disease
  • Testicular atrophy
  • Klinefelter’s syndrome
  • Drugs (e.g. spironolactone)
19
Q

What are the complications of long-term alcohol misuse?

A

Cardiovascular:
- Cardiomyopathy
- Hypertension

Liver/GI:
- Alcohol-related liver disease
- Pancreatitis
- Peptic ulcer disease
- UGI cancers

Neurological:
- Cerebellar atrophy
- Plyneuropathy
- Wernicke-Korsakoff’s syndrome

20
Q

What are the genetic causes of pancreatitis?

A
  1. Cystic fibrosis
  2. PRSS1
  3. SPINK1
21
Q

How can a patient be assessed for pancreatic exocrine insufficiency?

A

Clinically:
- Steatorrhoea
- Weight loss

Laboratory:
- FBC (anaemia)
- Albumin (low)
- Vitamin D (low)
- Magnesium (low)
- Faecal elastase (low in moderate - severe insufficiency))

22
Q

What are the main differences between Crohn’s disease and ulcerative colitis?

A

Crohn’s disease:
- Can affect any part of the GI tract
- Anal fissures are possible complications
- Inflammation affecting all layers of the intestines, making perforation possible
- Increased numbers of goblet cells
- Granuloma formation

Ulcerative colitis:
- Usually involves the rectum with variable length of colon but doesn’t spread beyond the ileocaecal valve
- No anal involvement
- Inflammation does not spread beyond submucosa so perforation unlikely
- Goblets cells depleted
- Crypt abscess formation
- Granulomas uncommon