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MRCP PACES revision > Abdominal Exam > Flashcards

Abdominal Exam Flashcards

1
Q

What are the causes of large kidneys?

A
  1. Unilateral
    - -ADPKD
    - -Hydronephrosis
    - -Renal tumour
    - -Congential (e.g. horseshoe)
  2. Bilateral
    - -ADPKD
    - -Hydronephrosis
    - -Bilateral tumour
    - -Amyloid
    - -Congenital renal anomalies
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2
Q

Causes of ESRF

A

Common causes

  • Diabetic nephropathy
  • ADPKD
  • Hypertension
  • Glomerulonephritis
  • Connective tissue disease
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3
Q

Side effects of Ciclosporin

A
  • Gum hypertrophy
  • Hypertrichosis
  • Skin malignancies
  • HTN/fluid retention
  • Hepatotoxic
  • Hyperkalaemia/lipidaemia

Dose related:

  • Tremor
  • Nephrotoxic
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4
Q

Immunsuppressants in solid organ transplants

A 
Corticosteroids
Ciclosporin
Tacrolimus
Azathioprine
Mycophenolate mofetil
Sirolimus
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5
Q

Side effects of Azathioprine

A 
Blood dyscrasias
TB reactivation
"Itis"
-Pancreatitis
-Interstitial nephritis
-Hepatitis
-Pneumonitis

Test for TPMT (thiopurine methyltransferase) as if patients defiecient - AZA not metabolised –> BM suppression

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6
Q

Side effects of Tacrolimus

A 
Dose related
	Nephrotoxic
	Tremor
Hepatotoxic
CVS
	HTN
	Fluid retention
Metabolic
	↑K+
	Hyperlipidaemia
Skin
	Hypertrichosis
	Gum hypertrophy
	Photosensitivity
	Skin neoplasms
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7
Q

Causes of chronic liver disease

A

Common

  • Alcohol
  • Viral hepatitis (B/C)
  • NAFLD

Congenital

  • Biliary atresia
  • Wilson’s
  • Haemochromatosis
  • Alpha1 antitrypsin
  • CF

Acquired

  • Autoimmune (PSC/PBC/AH)
  • Drugs (MTX, amiodarone etc)
  • Vascular (budd chiari, TR/RHD)
  • Cryptogenic
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8
Q

Causes of acute liver failure (<28d)

A

Infectious

  • Viral hepatitis A/B/D/E
  • HSV/VZV/CMV/EBV

Drug

  • Paracetamol
  • Idiosyncratic - multiple (NSAID, anti-TB meds, OCP, ABx)

Vascular

  • Ischaemia
  • Budd chiari

Autoimmune (AH)

Pregnancy

  • Acute fatty liver disease in pregnancy
  • HELLP

Wilson’s
Malignant infiltration

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9
Q

What are the complications of a liver transplant?

A

Immediate

  • Bleeding
  • Very early graft failure

Early

  • Biliary leak/strictures
  • Infection (CMV, viral, fungal, sepsis)
  • Vascular (HA thrombosis/stenosis, PV thrombosis, IVC stenosis)
  • Acute rejection
  • GVHD

Late

  • Disease recurrence
  • sdRenal failure
  • HTN/DM
  • Malignancy
  • Osteodystrophy
  • Chronic rejection
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10
Q

Causes of Leuconychia

A

Hypoalbuminaemia
Idiopathic
Hereditary
Drugs/toxins: sulphonamides, arsenic, heavy metal poisoning

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11
Q

Causes of Koilonychia

A 
IDA
Idiopathic
Familial (nail patella syndrome)
Physiological (neonates)
Occupational
Altitudinal
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12
Q

Peripheral signs of ESRF

A

Leuconychia
Half and Half nails
Mees’ lines (white lines, no pitting)
Beau’s lines (white lines, pitting)

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13
Q

Causes of clubbing

A
  1. Respiratory
    - -Suppurative lung disease (bronchiectasis, empyema)
    - -Pulmonary fibrosis
    - -Lung cancer
    - -Mesothelioma
  2. Abdominal
    - -IBD
    - -Cirrhosis
    - -Coeliac disease
  3. Cardiac
    - -Endocarditis
    - -Atrial myxoma
    - -Cyanotic heart disease
  4. Other
    - -Idiopathic/Familial (AD)
    - -Thyroid acropachy
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14
Q

Causes of spider naevi

A

> 5 pathological

Normal in childhood
Pregnancy
OCP
CLD
Thyrotoxicosis
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15
Q

Causes of Abdominal distension

A

5 F’s:

  1. Fat
  2. Flatus
  3. Faeces
  4. Fluid
  5. Fetus
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16
Q

How do you differentiate the spleen from the kidney on examination?

A
  1. Kidney is ballotable
  2. Cannot get above spleen
  3. Spleen is dull to percussion
  4. Spleen has a notch
  5. Spleen moves with inspiration
17
Q

Causes of pedal oedema

A
  1. Unilateral
    - Venous obstruction
    - Lymphatic obstruction
  2. Bilateral
    - Heart failiure
    - Renal failure
    - Hypoalbuminaemia
    - Nephrotic syndrome
    - Thyroid disease (myxodema)
18
Q

What do you need to complete the abdominal examination?

A
  1. External genitalia/PR
  2. Hernial orifices
  3. Urine dip
  4. Fundi (if renal case)
19
Q

Peripheral signs of liver disease

A
  1. Nails
    - Leuconychia
    - Clubbing
  2. Hands
    - Palmar erythema
    - Dupuytren’s
    - Asterixis
  3. Arms
    - Jaundice
    - Bruising
    - Excoriation
    - Tattoos
20
Q

Signs of Portal Hypertension

A
  1. Varices on endoscopy
  2. Splenomegaly
  3. Caput medusa
  4. Ascites
21
Q

What indicates decompensated chronic liver disease?

A
  1. Jaundice
  2. Encephalopathy (asterisks)
  3. Variceal bleed
  4. Ascites
  5. Coagulopathy (bruising)
  6. Hepatorenal syndrome
  7. Hepatopulmonary syndrome
22
Q

Grading of hepatic encephalopathy

A

0 - Mild memory/mentation disturbance
1 - Mild confusion/depression/euphoria
2 - Drowsy, mild disorientation for time, personality change
3 - somnolent but rousable, grossly confused, speech incomprehensible
4 - comatose

*Asterixis present in 2/3/4

23
Q

What is Hepatorenal syndrome?

A 
Severe splanchnic vasodilatation:
o	↓Venous return
o	↓CO
o	↓effective arterial volume
o	↑renal arterial vasoconstriction

Type 1 - Rapid onset
Type 2 - Gradual onset

24
Q

How do you manage ascites in CLD?

A
  1. Reduced salt diet
  2. Spironolactone (100-400mg)
  3. Furosemide 2nd
  4. Therapeutic paracentesis
  5. TIPPS
  6. Liver Tx
25
Q

What is included in the Child-Pugh Score?

A 
A – Albumin
B – Bilirubin
C – Clotting (INR)
D – Distension
E – Encephalopathy

Grade A to C

26
Q

What are the causes of ascites?

A

SAAG >11g/dL

  • Cirrhosis
  • Heart failure
  • Hypoalbuminaemia

SAAG <11g/dL

  • Malignancy
  • TB
  • Serositis in autoimmune disease
  • Pancreatitis
27
Q

What are the causes of hepatomegaly?

A

Common:

  • Cirrhosis
  • Cancer
  • Cardiac failure
Others:
Infective
-Glandular fever
-Viral hepatitis
Infiltrative
-Sarcoid
-Amyloid
-Haemochromatosis

Lympho/myeloproliferative disorders

28
Q

What causes splenomegaly?

A
  1. Massive splenomegaly
    - CML
    - Myelofibrosis
    - Kala-azar/visceral leishmaniasis
    - Malaria
  2. Non-massive
    - Myeloproliferative
    - Lymphoproliferative
    - Portal HTN from CLD
    - Congestive (RHF)
    - Infective (mononucleosis, malaria, endocarditis, brucella)
    - Autoimmune (felty, SLE)
    - Infiltrative (sarcoid/amyloid)

MRCP PACES revision (8 decks)

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