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PACES > Abdominal Station > Flashcards

Abdominal Station Flashcards

1
Q

Causes of splenomegaly

A
  1. Work hypertrophy
    - RBC sequestration (haemaglobinopathies, membranopathies)
    - Immune-mediated (malaria, HIV, EBV, infective endocarditis, visceral leishmaniasis, RA, sarcoidosis, thyrotoxicosis)
    - Extra-medullary haematopoiesis (ET, PV, MF)
  2. Infiltration
    - Neoplasms (lymphoma, leukaemia, metastasis)
    - Metabolic (Gaucher’s, amyloidosis)
    - Cysts/abscesses
  3. Congestion (PHT, CCF)
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2
Q

Myeloproliferative disorders

A

Chronic myeloid leukaemia
Essential thrombocytosis
Polycythaemia rubra vera
Primary myelofibrosis

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3
Q

Splenomegaly vs Renal Mass on Clinical Exam

A

Splenic notch
Getting above the mass
Percussion
Ballot
Movement with inspiration
Direction of enlargement

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4
Q

Felty’s syndrome

A

Rheumatoid arthritis
Splenomegaly
Neutropaenia (recurrent infections)

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5
Q

Causes of massive splenomegaly

A

Myeloproliferative disorders (CML and myelofibrosis)
Visceral leishmaniasis
Chronic malaria

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6
Q

Causes of hepatomegaly

A

Cirrhosis
Congestive cardiac failure
Carcinoma (HCC, metastasis)
Infections (Hep B + C)
Autoimmune (AIH, PBC, PSC)
Infiltrative (myeloproliferative disorders, sarcoidosis, amyloidosis)

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7
Q

Causes of cirrhosis

A

Alcohol-related liver disease
Non-alcoholic fatty liver disease
Chronic viral hepatitis (Hep B & C)
Autoimmune (AIH, PBC, PSC)
Haemachromatosis
Wilson’s disease
Alpha-1 antitrypsin deficiency
Drug-induced (methotrexate)

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8
Q

Indications for liver transplant

A

Cirrhosis
Hepatocellular carcinoma
Acute liver failure (i.e. paracetamol overdose)

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9
Q

Complications of immunosuppression

A

Infection (CMV, VZV, PCP)
Malignancy (skin cancer - SCC and BCC)
Post-transplant diabetes mellitus
Hypertension
Dyslipidaemia
Weight gain
IHD
CVA

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10
Q

Criteria used in selecting patients for liver transplants

A

Chronic: UKELD score (49+)
Acute: KCH (paracetamol-induced vs non-paracetamol-induced)

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11
Q

Immunosuppressive agents used in organ transplants and their side effects

A

Calcineurin inhibitors: tacrolimus (tremor, paraesthesia, nephrotixicity), ciclosporin (gingival hypertrophy, hypertrichosis , nephrotoxicity)

Antiproliferative agents: MMF (nausea, diarrhoea, bone marrow suppression), azathioprine (alopecia, seborrheic keratosis, bone marrow suppression)

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12
Q

Haemochromatosis symptom triad

A

Fatigue
Arthralgia
Sexual dysfunction

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13
Q

Complications of haemochromatosis

A

Cirrhosis
T1DM
Skin discolouration (bronze or slate-grey)
Anterior pituitary dysfunction
Arthropathy (chondrocalcinosis)
Cardiomyopathy
Hepatocellular carcinoma

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14
Q

Investigations for haemochromatosis

A

Blood glucose and HbA1c
Iron studies: ferritin (>300 in men, >200 in women) and transferrin >45%
Alpha-fetoprotein
Liver ultrasound, fibroscan
ECG
CXR
Echo
Genotyping

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15
Q

Treatment of haemochromatosis

A

Regular venesection
- 1 unit/week until ferritin 20-30, transferrin saturation <50%, then 1 unit 3-4 times per year

Avoid alcohol

Monitor for HCC

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16
Q

Genetics of haemochromatosis

A

Autosomal recessive
HFE gene on chromosome 6
Most common mutation C282Y

17
Q

Causes of a high SAAG (>1.1 mg/dL)

A

Cirrhosis
CCF
Alcoholic hepatitis
Fulminant hepatic failure
Portal vein thrombosis
Budd-Chiari syndrome
Meig’s syndrome

18
Q

Causes of a low SAAG (<1.1 mg/dL)

A

TB
Pancreatitis
GI or ovarian malignancy
Peritoneal carcinomatosis
Nephrotic syndrome

19
Q

Triad of hereditary spherocytosis

A

Pallor
Jaundice
Splenomegaly

20
Q

Pathophysiology of hereditary spherocytosis

A

Autosomal dominant condition
Mutation in one of 5 membrane proteins
Biconcave -> spherocyte
Sequestration in the spleen
Haemolysis

21
Q

Investigations for hereditary spherocytosis

A

Hb
Blood film
Bilirubin
LDH
Haptoglobin
Reticulocyte count
DAT

EM binding test
Osmotic fragility testing
Flow cytometry

22
Q

Management of hereditary spherocytosis

A

Mild: supportive
Moderate: supportive + consider splenectomy
Severe: splenectomy

Also consider cholecystectomy as these patients may have gallstones

23
Q

Preoperative vaccination before splenectomy

A

Pneumococcal vaccine
Meningococcal vaccine
Haemophilis influenza vaccine

24
Q

Postoperative splenectomy Mx

A

Prophylactic antibiotics (for at least 3 years)
Keep vaccines up to date

25
Q

Complications of liver cirrhosis

A

Portal hypertension
Ascites
Spontaneous bacterial peritonitis
Hepatic encephalopathy
Variceal haemorrhage
Hepatorenal syndrome
Hepatopulmonary syndrome

26
Q

Management of ascites in CLD

A

Low salt diet (<5.2 g/day)
Spironolactone
Furosemide
Repeated ascitic taps
TIPS

27
Q

Common causes of ascites

A

Cirrhosis with PHT
Congestive cardiac failure
Nephrotic syndrome
Malignancy

28
Q

Causes of pancreatitis

A

G - Gallstones
E - Ethanol
T - Trauma
S - Steroids
M - Mumps or malignancy
A - Autoimmune
S - Scorpion sting
H - Hypertriglyceridaemia or hypercalcaemia
E - ERCP
D - Drugs: Azathioprine, HCTZ, co-trimoxazole

Genetic causes: PRSS1, CFTR, Spink1

29
Q

Features of pancreatic insufficiency

A

Weight loss
Diarrhoea
Steatorrhoea
Low Vit D
Low Mg
Low faecal elastase

30
Q

Causes of palmar erythema

A

Cirrhosis
Polycythaemia
Pregnancy
Hyperthyroidism
Rheumatoid arthritis

31
Q

Features: Crohn’s disease vs. Ulcerative Colitis

A

UC: colon and rectum only, continues lesions, mucosal or submucosal, crypt abscesses

Crohn’s disease: anywhere in the alimentary canal, skip lesions, transmural, granulomas

32
Q

Treatment of IBD

A

Therapy to induce remission
Maintenance therapy

Medical:
Mesalazine (oral or topical)
Steroids (oral or topical)
Immunosuppressive agents (ciclosporin, azathioprine)
Biologicals (inflixamab, vedolizumab, ustekinumab)

Surgery

Other: dietician, TPN, stoma nurse, VTE, stop smoking

33
Q

Indications for surgery in IBD

A

Poor response to medical therapy
Toxic megacolon
Perforation
Haemorrhage

34
Q

Indications for splenectomy

A

Chronic ITP
Trauma
Hereditary spherocytosis
Sickle-cell disease
Primary splenic malignancy

35
Q

Genetics of ADPKD

A

PKD1 mutation in chromosome 16 (85%)
PKD2 mutation on chromosome 4 (15%)

36
Q

Ultrasound criteria for ADPKD

A

< 40: 3 cysts total on one or both kidneys

40 - 60: 2 cysts on both kidneys

> 60: 4 cysts on both kidneys

37
Q

Extra-renal manifestations of ADPKD

A

Cysts elsewhere (liver, pancreas, arachnoid)
Berry aneurysms
Mitral valve prolapse

PACES (6 decks)

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