Abdominal Flashcards
Evidence of Hepatic Decompensation
Ascites
Asterixis
Altered consciousness - encephalopathy
Causes of Hepatomegaly
Cirrhosis Carcinoma Congestive cardiac failure Infectious HBV HCV Immune PBC PSC Autoimmune Infiltrative amyloid, myeloproliferative
Child-Pugh Score 1 year prognosis
5-6 = A = 100% 7-9 = B = 81% 10-15 = 45%
Causes of Ascites
Cirrhosis
Carcinomatosis
Congestive cardiac failure
Rare: Meig’s syndrome, hypothyroidism, serositis in familial Mediterranean fever
Causes of Palmar Erythema
Hyperthyroidism Rheumatoid Cirrhosis Pregnancy Polycythaemia
Causes of Gymaecomastia
Constitutional
- puberty
- senility
- Kleinfelter’s
Secondary
- Cirrhosis
- Iatrogenic
- Drugs - spironolactone and digoxin
- Testicular tumour/orchidectomy
- Endocrinopathy (hyperthyroidism, Addison’s)
Complications of Haemochromatosis
Diabetes - signs
Dilated cardiomyopathy - HF
Arthritis - replacements
HCC - scars of removal
Blood profile of Haemochromatosis
Ferritin raised
Transferring saturation raised
Total iron binding capacity decreased
Mutations of Haemochromatosis
Autosomal recessive Chromosome 6 C282Y H63D Homozygous prevalence 1:300 Carrier 1:10 Penetrance low
Causes of Splenomegaly
Massive splenomegaly:
- CML and myelofibrosis
- Malaria, kala-azar, visceral leishmaniasis
Moderate splenomegaly
- myelo/lymphoproliferative disorders
- infiltrative disorders such as Gaucher’s and amyloidosis
Tip
- myelo/lymphoproliferative disorders
- portal hypertension
- infections (EBV, infective endocarditis, hepatitis)
- haemolytic anaemia
Top three causes for renal transplant
Glomerulonephritis
Diabetic nephropathy
Polycystic kidney disease
Top three causes for liver transplantation
Cirrhosis
Acute hepatic failure (A, B, paracetamol)
Hepatic malignancy
Complications of PEG
Immediate: endoscopy related, perforation, haemorrhage, aspiration, over sedation
Early: lieus, pneumoperitoneum, wound infection, wound leakage, trauma
Late:
Abdomen: gastric outlet obstruction, peritonitis, peristomal leakage or infection, skin and gastric ulceration, gastric fistula, granulation around site of insertion
Tube: blockage, dislodge, degradation, buried bumper syndrome (rare but important)
Causes of renal cysts
Polycystic kidney disease Simple cysts Medullary cystic disease Acquired cystic disease secondary to scarring Von hippel lindau syndrome
Causes of membranous glomerulonephropathy
Idiopathic: Primary Infection: HIV, syphillis, Hep B, malaria Infiltrative: amyloid Autoimmune: SLE Metabolic: diabetes Neoplasia: NHL, carcinoma, melanoma Drugs: gold, penicillamine
Causes of UGI bleed
Peptic ulcer Oesophagitis Erosive disease Varices Mallory-Weiss tear Neoplasm Vascular malformation Aorto-GI fistula
Causes of bowel ischaemia
Arterial:
Occlusion/embolus, Thrombotic/atherosclerosis, dissection, vasculitis, fibromuscular dysplasia, trauma, endotoxins
Hypoperfusion:
Cardiogenic shock, septic shock
Venous:
Thrombus, inflammation, neoplasm, drugs
Extravascular:
Volvulus, adhesions, incarceration
Causes of lower GI bleeding
Bleeding below ligament of Trietz
Diverticula Haemorrhoids IBD Infective Ischaemic colitis Post polypectomy Colorectal cancer Angiodysplasia
Urinary Casts
Tubular casts - ATN, interstitial nephritis
Hyaline casts - Tamm-Horsfall glycoprotein
Granular casts - non specific
Red cell casts - glomerulonephritis
White cell casts - ATN or pyelonephritis
Indications for haemofiltration in acute renal failure
Refractory acidosis
Refractory hyperkalaemia
Pulmonary oedema
Uraemia encephalopathy
Pre-renal compared to Renal failure
Ability to concentrate urine unaffected. Hence:
- Urine osmolality high
- Urine osm: plasma osm high
- Urine creatinine: plasma creatinine high
- Urine sodium low
