Abdominal Exam Flashcards
Causes of liver cirrhosis
Alcohol
Viral - hep B and C
Autoimmune - PBC, PSC, auto hep
Metabolic - NAFLD, haemochromatosis, alpha-1 antitrypsin deficiency, Wilsons disease, cystic fibrosis
Drugs - metronidazole isoniazid amiodarone, phenytoin
Consequences of cirrhosis
Portal hypertension – oesophageal varices, ascites hypersplenism
Liver dysfunction - coagulopathy encephalopathy, jaundice, hypoalbuminaemia
HCC
Causes of hepatomegaly
Malignancy (1 + 2)
Cirrhosis - NAFLD, ALD, PBC
Hepatic congestion - R heart failure, constrictive pericarditis, restrictive cardiomyopathy
Alcoholic hepatitis
Infected - viral, toxoplasmosis, hydatid dz, amoebic/pyrogenic abscess
Infiltration - amyloid, sarcoidosis, glycogen storage disorders
Vascular - budd-chiari, sickle cell
Polycystic liver disease
Causes of decompensation in cirrhosis
Infection SBP (>500 neutrophils/microlitre) Hypokalemia (decreases renal ammonia clearance) GI bleeding Sedatives HCC
Cancers which commonly metastasise to liver
Colorectal Breast Oesophageal Lung Gastric Renal Endometrial Sarcoma Bone
Name some benign liver tumours
Cavernous haemangioma - most common benign
Hepatic adenoma
Focal nodular hyperplasia
Infective causes of acute hepatitis
Hep A B C E EBV CMV Toxoplasmosis HSV
Causes of massive splenomegaly
CML myelofibrosis Malaria AIDS with mycobacterium avium complex visceral leishmaniasis
Causes of moderate splenomegaly
Portal hypertension lymphoma leukaemia (Acute or chronic) Thalassaemia Glycogen and lipid storage diseases
What are the cytogenetics of CML?
The Philadelphia chromosome is present in 90 to 95% of patients with CML. This is a translocation of chromosome 9 and 22 leading to increased oncogene activity through tyrosine kinase
What are the causes of hyposplenism?
Splenic infarction (sickle-cell anaemia, vasculitis)
Splenic artery thrombosis
Infiltrative conditions (amyloid, sarcoid)
Coeliac disease
Autoimmune disease
What is Felty’s syndrome?
Rheumatoid Arthritis with splenomegaly and neutropenia
How do you diagnose haemochromatosis?
Transferrin sats >60% in males, >50% in females
Liver biopsy to confirm Dx
Complications of haemochromatosis
HCC - needs 6monthly surveillance (USS and alpha fetoprotein)
Diabetes (decreased insulin sensitivity)
Arthropathy
Restrictive or dilated cardiomyopathy
Major causes of chronic renal disease in developed world
Hypertension Diabetes Glomerulonephritis Polycystic kidneys Reflux nephropathy
What are the complications of CKD?
Fluid overload Hyperkalaemia Hyperphosphataemia Metabolic acidosis Renal osteodystrophy (low Ca and vit D, high phos and PTH) Anaemia
What is renal osteodystrophy?
In End stage CKD, you get reduced phos excretion and decreased conversion of vit D3 to calcitriol (active form)
-> low Ca -> 2ndary high PTH -> altered bone mineralisation
Osteitis fibrosa - increased bone turnover, bone cysts
Osteomalacia - decreased mineralisation,
Adynamic bone disease - MOST COMMON. Bone turnover markedly reduced, no mineralisation defect
Indications for renal replacement therapy
Uraemic pericarditis/pleuritis/encephalopathy
Volume overload refractory to diuretics
Hypertension refractory to antihypertensives
Refractory hyperkalaemia/acidosis
Define nephrotic syndrome
Hypoalbuminaemia 3g/24hours
Oedema
Causes of nephrotic syndrome
Systemic - DM, SLE, amyloidosis Renal: Minimal change disease - idiopathic, secondary to DM, NSAIDS, HIV, paraneoplastic Hodgkin's lymphoma, IgA nephropathy Focal segmental glomerulosclerosis Membranous GN Mesangiocapillary GN
What is the inheritance of haemochromatosis?
which chromosome?
auto recessive chrom 6
What is the inheritance of haemochromatosis?
which chromosome?
auto recessive chrom 6
Causes of unilateral kidney enlargement
polycystic kidney disease
renal cell carcinoma
simple cyst
obstructive hydronephrosis
Causes of bilateral kidney enlargement
renal cell carcinoma bilateral hydronephrosis polycystic kidney disease tuberous sclerosis amyloidosis
genetics of polycystic kidney disease?
85% ADPKD1 chrom 16
15% ADPKD2 chrom 4
other organ involvement with PKD
hepatic cysts and hepatomegaly
intracranial Berry aneurysms
mitral valve prolapse
Causes for renal transplant
glomerulonephritis
diabetic nephropathy
ADPKD
Causes for renal transplant
glomerulonephritis
diabetic nephropathy
ADPKD
Differential diagnosis for Crohn’s disease
UC
Yersinia
TB
lymphoma
Differential Diagnosis for UC
Crohns infection (campylobacter) ischaemic bowel drugs radiation
Treatment of Crohns disease
mild-mod - oral steroids, mesalazine
severe - IV steroids, IV infliximab
maintenance - steroids, azathioprine, methotrexate, infliximab
Treatment of UC
mild - mod: rectal steroids, mesalazine
severe: IV steroids, IV ciclosporin
maintenance: oral steroids, 5-ASA, azathioprine
Treatment of UC
mild - mod: rectal steroids, mesalazine
severe: IV steroids, IV ciclosporin
maintenance: oral steroids, 5-ASA, azathioprine
complications of Crohns
malabsorption anaemia fistula abscess SBO from strictures
Complications of UC
anaemia
toxic megacolon
perforation
colonic carcinoma (high risk with pancolitis)
extra-intestinal manifestations of IBD
mouth: apthous mouth ulcers
skin: clubbing, pyoderma gangrenosum, erythema nodosum
eyes: uveitis, episcleritis, iritis
