Abdominal

Question 0

Causes of CLD

Answer 0

Commonest = alcohol + viral
Toxins: alcohol, drugs (amiodarone, methotrexate)
Viral: hepB, hepC, CMV, EBV
Metabolic: non-alcoholic steatohepatitis, haemochromatosis, wilsons, alpha-1-antitrip
Autoimmune: AIH, PBC, PSC
Neoplasm: HCC, mets
Vasc: Budd-Chiari, RHF

Question 1

CLD complications

Answer 1

Portal hypertension (ascites, hypersplenism, varices)
Synthetic dysfunction (albumin, clotting)
Hepatic encephalopathy
Hepatorenal
Hepatopulomary
HCC

Question 2

Hepatosplenomegaly causes

Answer 2

Portal HTN
CML
Non-Hodgkins lymphoma
Infective endocarditis
Myelofibrosis
Infiltration (amyloidosis)
Granulomatous disease (TB, sarcoid, wegeners)
Other infectious (malaria, kala-azar, schisto)

Question 3

Hepatomegaly causes

Answer 3

Cirrhosis
CCF
Neoplastic (Mets and primary)
Infective: acute viral, liver abscess
Polycystic disease
Tricuspid regurg
Budd-Chiari
Haemochromatosis
Infiltration: amyloidosis, sarcoidosis

Question 4

Splenomegaly causes

Answer 4

Cirrhosis with portal hypertension
Myeloproliferative: CML, myelofibrosis
Lymphoma
Infections: endocarditis, EBV, CMV, malaria, kala-azar
SLE, RA, scleroderma, sarcoidosis
Haemolytic anaemias

Question 5

Causes of asterixis

Answer 5

Hepatic encephalopathy
Uraemia
Hypercapnea
Electrolytes: hypoglycaemia, hypokalaemia, hypoMg
Drug intoxication: barbiturates, phenytoin, alcoholism

Question 6

Precipitants of hepatic encephalopathy

Answer 6

Increased nitrogen: constipation, GI bleed, blood transfusion, infection, hypokalaemia
Decreased toxin clearance: dehydration, hypotension, anaemia, portosystemic shunts
Altered neurotransmission: benzos, psychoactive drugs
Hepatocellular damage: continued alcohol use, HCC

Question 7

Examination findings of encephalopathy

Answer 7

Confusion
Hyper-reflexia
Rigidity
Asterixis
Myoclonus
Hippus (rhythmic dilation/constriction of pupil)

Question 8

PBC associated AI conditions

Answer 8

RA, thyroid, Sjögrens, scleroderma, SLE, coeliac

Question 9

PBC treatment

Answer 9

Ursodeoxycholic acid or cholestyramine.

Liver transplant

Question 10

What does haemochromatosis affect?

Answer 10

Liver
Joints
Heart
Skin
Endocrine

Question 11

Wilsons diagnostic tests

Answer 11

Low serum copper and caeruloplasmin
High 24-hour urinary copper
Gold standard is liver biopsy
ATP7B gene analysis

Question 13

Wilson’s disease management

Answer 13

D-penicillamine and trientine promote excretion

Penicillium in not used for neuropsych symptoms, use zinc salts instead and for presymptomatic patients

Question 14

Causes of ascities

Answer 14

Cirrhosis
CCF/RHF
Intra-abdominal malignancy
Hypoalbuminaemia
Uncommon (nephrotic syn, TB, chylous)

Question 15

Causes of portal hypertension

Answer 15

Pre-hepatic: thrombosis
Hepatic: cirrhosis
Post-hepatic: Cardiac (RHF, TR), Budd-Chiari

Question 16

Ascites treatment

Answer 16

Treat underlying condition, daily weights, fluid + salt restrict, diruetics (spiro).
Therapeutic paracentesis (give HAS)
If diuretic-resistant - shunting (TIPS, peritoneovenous) or transplant

Question 17

Jaundice causes

Answer 17

Commonest = Haemolysis, CLD, gallstones
Pre-hepatic: haemolysis (AIHA, HS, SCD, G6PD, malaria)
Hepatic: CLD, Hepatitis (EtOH, viral), Drugs (para, statins, anti-TB), Congential, AIH, Ca
Post-hepatic: Gallstones, Panc Ca, PBC, PSC, cholestasis (OCP, augmentin)

Question 18

Differential for Mercedes Benz Scar

Answer 18

Hepatobiliary surgery

• Liver transplant
• Segmental resection
• Whipples’: pancreaticoduodenectomy

Question 19

Differential for bilateral renal enlargement

Answer 19

APKD
Bilateral hydronephrosis
Amyloidosis
Tuberous sclerosis
Von-Hippel-Lindae disease

Question 20

APKD associations

Answer 20

Liver, splenic, pancreatic cysts
Heart: mitral valve prolapse, AR
Intracranial aneurysms
Colonic diverticula, abdo hernias

Question 21

Common causes of CKD

Answer 21

DM
GN e.g. IgA nephropathy
Reflux nephropathy
Obstructive nephropathy
Renovascular disease
Hypertension
Polycystic kidney disease