Abdominal Flashcards

1
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

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2
Q

What are the causes of ascites?

A
  • Chronic liver disease (most common)
  • Congestive heart failure
  • Malignancy
  • Pancreatitis
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3
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)
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4
Q

What are the indications for nephrectomy in ADPKD?

A
  • Recurrent UTIs
  • Chronic pain
  • RCC
  • Debulking for symtpom control or in preparation for transplantation
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5
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

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6
Q

What are the causes of massive splenomegaly?

A
  • CML
  • Myelofibrosis
  • Gaucher’s disease
  • Chronic malaria
  • Kala-azar (visceral leishmaniasis)
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7
Q

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

A
  • Gynaecomastia
  • Dupuytren’s contractures
  • Spenomegaly
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8
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

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9
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)
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10
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

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11
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
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12
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

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13
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
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14
Q

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

A
  • Malignancy
  • Infectious peritonitis
  • Pancreatitis
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15
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
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