Abdominal station Flashcards
single palpable kidney causes
PKD
Hydronephrosis
renal cyst
renal carcinoma
hypertrophy pf solitary functioning kidney
signs of PKD
resonant ballotable masses, oedema for renal failure, AV fistula, blood pressure and urine dip for renal failure
PKD associated with
berry aneurysms, hepatic cysts, mitral valve prolapse
PKD facts
Autosomal dominant
1 in 1000
HTN, UTI’s, cyst haemorrhage, haematuria
End stage renal failure at 40-60yo
DDx for bilateral kidney masses
ADPCKD, bilateral renal cysts, bilateral renal cell carcinoma, bilateral hydronephrosis, amyloidosis, tuberous sclerosis
Abdo causes of clubbing
Hepatic cirrhosis
Coeliac disease
Ulcerative colitis
Crohn’s disease
GI lymphoma
What is IBS?
Recurrent abdo pain for 1d/week for 3 months with association with defecation, change in frequency of stool, change in form of stool
IBS treatment
Conservative = advice, FODMAP, CBT
Medical = bulk forming laxatives, analgesia = mebeverine, loperamide for diarrhoea
Coeliac disease…
Villous atrophy, from gliadin + gluten. Associated with other autoimmune conditions
Extra intestinal = dermatitis herpetiformis, anaemia, hyposplenism, osteomalacia, T cell lymphoma
Coeliac disease investigations
Ensure eating gluten for 6w prior to testing
1st line = IgA TTG levels + Serum IgA levels
+ve = endoscopy + duodenal biopsy = increased intraepithelial lymphocytes, villous atropy, crypt hyperplasia
2nd line = IgA EMA
UC treatment acute severe disease
Signs = >6 stools, frank blood, fever, HR >90, anaemia, ESR>90
admit + IV hydrocortisone
If no improvement at 72 hours = IV ciclosporin + biologics then surgical input
UC non-severe treatment
Pancolitis = Topical + oral aminosalicylate if no improvement at 4 weeks = oral corticosteroids
Proctitis, proctosigmoiditis, L sided colitis = topical aminosalicylate if no improvement at 4w = oral corticosteroids
Toxic megacolon
UC or C.diff infection
3-6-9 rule
IV hydrocortisone + infliximab
Renal transplant signs
AV fistula. If no needle marks, no thrill, thrombosed = non-functioning
Glucose monitoring marks on finger
Rutherford Morrison scar, flank scar
Renal failure signs
cachexia, old AV fistula scars, peritoneal catheters, pulmonary and peripheral oedema, pallor
Indications for renal transplant
- Diabetic nephropathy
- Polycystic kidney disease
- Glomerulonephritis
complications of renal transplant
- Rejection
- Cushing syndrome
- Skin malignancy (BCC + SCC)
- Ciclosporin = gym hypertrophy
signs of splenomegaly
Dull mass, moves with respiration and non-ballotable
Beyond midline = massive splenomegaly
Unable to palpate liver edge = tense ascites
causes of splenomegaly
Haematological = CML, myelofibrosis, spherocytosis
Infective = malaria, EBV
Other = portal hypertension, amyloidosis, sarcoidosis
causes of hepatomegaly
Haem = CML
Infective = malaria, EBV
Other = amyloidosis, sarcoidosis
indications for splenectomy
Traumatic rupture, idiopathic thrombocytopaenia, spherocytosis