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Final Prep > AS PACES Abdo > Flashcards

AS PACES Abdo Flashcards

1
Q

Child Pugh grading cirrhosis

A

A, B, C
ABCDE = albumin, bilirubin, clotting, distension (ascites), encephalopathy
Correlates with mortality: A (score 5-6); C (score 10-15) 1 yr mort 50%

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2
Q

Decompensated LD - precipitants

A

HEPATICS
Haemorrhage, electrolytes, poisons (diuretics, sedatives), alcohol, tumour, infection (SBP, pneumonia, UTI), Constipation (commonest), Hypoglycaemia (malnutrition)

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3
Q

Hepatic encephalopathy - presentation

A 
Asterixes, ataxia
Confusion
Dysarthria
Constitutional apraxia
Seizures
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4
Q

Hepatic encephalopathy - Mx

A

Nurse in well lit, calm environment
Correct precipitants
Avoid sedatives
Lactulose - decrease nitrogen forming bowel bacteria

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5
Q

Hepatorenal syndrome

A 
Cirrhosis = splanchnic vasodilation = reduction in ECV = RAS activation = renal arterial vasoconstriction = failure
Type 1 (rapidly progressing) - survival 2wks
Type 2 (steady decline) - survival 6mo
IV albumin + terlipressin ± haemodyalisis ± liver transplant
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6
Q

SBP

A 
Ascitis and peritonitis abdomen
Complicated by HRS in 30%
E. Coli, Klebsiella, Strep
Ascitic tap = PMN >250mm3 + MC&S
Possible for ciprofloxacin to be given as prophylaxis against SBP
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7
Q

Causes of ascites

A

80% cirrhosis with portal HTN
CCF
Carcinomatosis
SAAG = Se albumin - Ascites albumin; >1.1g/dL = portal HTN (if <1.1 Ca, pancreatitis, nephrotic syndrome

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8
Q

Diagnosing Portal HTN

A

Serum Ascites Albumin Gradient >1.1g/dL
TE
Portal presure >10mmHg (norm 5-10)

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9
Q

Causes of Portal HTN

A

Pre hepatic - Portal vein thrombosis
Hepatis - Cirrhosis
Post hepatic - Bubb-Chiari syndrome, RHF, TR

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10
Q

Ascites Tx

A

Conservative - no ETOH, fluid monitoring (aim 0.5kg/d reduction), fluid restrict <1.5L/d, low Na diet
Spironolactone
Therapeutic paracentesis
Refractory - TIPSS or transplant

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11
Q

DDx jaundice

A

Pre hepatic - Unconjugated. AIHA, HS, SCD, PNH, MAHA, malaria, G6PDD
Hepatic - CLD, paracetamol, statins, Ca
Post hepatic - conjugated, GA, Ca Panc, PBC, PSC, cholangiocarcinoma, OCP, augmentin

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12
Q

Immunosupression signs on peripheral examination

A

Cushingoid
Skin tumours - SCC, BCC, MM, AKs
Gingival hypertrophy

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13
Q

Ddx Rooftop scar

A

Liver transplant
Segmental resection
Whipples pancreatoduodenectomy

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14
Q

Liver transplant - causes, success rates, immunosupression regimen

A

Cirrhosis, acute liver failure, malignancy
80% 1 yr survival; 70% 5 yr survival
Tacrolimus / ciclosporin, azathioprine ± prednisolone

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15
Q

Causes of hepatomegaly

A

Hepatitis - ETOH, viral, NAFLD
Congestion - RHF, TR, budd chiari
Malignancy
Anatomical - Riedel’s lobe, hyperexpanded chest
Haem - leukaemia, lymphoma, myeloproliferative, SCD
Sarcoid, Amyloid, ADPKD

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16
Q

Splenomegaly DDx

A

Massive –> Myeloproliferative (CML, MF); Lymphoproliferative (CLL, lymphoma); Infiltrative (amyloid); Infectious (malaria, visceral leishmaniasis)
Small –> Haem proliferative, portal HTN, EBV, IE, malaria, RA, SLE, Sjorgen’s

17
Q

Blood film: Myelofibrosis, CLL, Haemolysis

A

MF –> leukoerythroblastic, teartrop poikilocytes (Jak2 mutation in 50%)
CLL –> Smudge cells (Ph chr t9;22)
Haemolysis –> spherocytes, reticulocytosis

18
Q

CML

A

Clonal proliferation of myeloid cells, 15% leukaemia
B symptoms, massive HSM, platelet dysfunction, gout, hyperviscosity
Ph Chr t(9;22) in >80% –> resulting BCR-ABL gene = tyrosine kinase activity
Imatinib or allogenic SCT (if blast crisis or TKi refractory)

19
Q

Primary myelofibrosis

A

Clonal expansion of megakaryocytes, ++ PDGF
B symptoms, massive HSM, BM failure
Leukoerythroblastic teardrop poikilocytes on film
Cytopenias, BM often dry tap
50% Jak2 + ve
Splenectomy ± allogenic BMT, other than that treatment supportive with blood products

20
Q

Hypersplenism

A

Pancytopenia due to pooling and destruction in large spleen (anaemia, bruising, infections)

21
Q

Hyposplenism

A

Ddx splenectomy, coeliac disease, IBD, SCD
Howell Jolly bodies, pappenheimer bodies, target cells
Mx –> immunisation (HiB, pneumovax, Men C, flu)
Abx –> Pen V or erythromycin
Warning alert card / bracelet

22
Q

Splenectomy - indications and complications

A 
Trauma, rupture, AIHA, ITP, HS
Early VTE - need post op aspirin
Transient ileus - post op NG tube
Atelectasis
Pancreatitis
Susceptibility to infections by encapsulated bacteria (haemophilus, pneumo, meningo)
23
Q

Mx APDKD

A

1:1000, PKD1 chr 16 85%; PKD2 chr 4 15%
Conservative - ensure good hydration, less caffeine, genetic counselling
Monitor U&E & BP, MRI for Berri aneurysms
Medical –> HTN (aggressively, target <130/80)
Surgical –> nephrectomy if recurrent bleeds / infections / abdo discomfort
Prognosis –> ESRF 70% by 70 yrs

24
Q

ARPDK

A

1:400000, perinatal presentation with oligohydramnios

ESRF 20 yrs, need Tx

25
Q

Tuberous sclerosis

A

AD, hamartomas in skin brain eye kidney
Skin –> nasolabial adenoma sebaceum, ash-leaf macules, peri ungal fibromas
Neuro –> Low IQ, epilepsy, astrocytoma
Renal –> cysts, angiomyolipomas

26
Q

RCC

A

90% renal Ca, median 55yrs, m:f 2:1
RF: smoking, obesity, HTN, dialysis (15% pts), 4% heritable (VHL)
AC from proximal renal tubular epithelium
Clear cell (glycogen) subtype: 70-80%
50% incidental finding, haematuria, loin pain, loin mass
Cannonball mets –> SOB
Paraneoplastic –> EPO, PTHrP, renin, ACTH
Spread: renal vein, lymph, haematogenous bone liver lung

27
Q

VHL syndrome

A 
AD, renal and pancreatic cysts
B/L RCC
Haemangioblastomas (often cerebellum)
Phaeochromocytoma
Islet cell tumours
28
Q

RCC Mx

A

Medical - for poor prognosis, temsirolimus (mTOR)
Surgical - radical nephrectomy
45% 5yr survival

29
Q

Commonest indications for renal Tx

A

DM
GN
PKD
HTN

30
Q

Assessment for renal Tx

A 
Virology: CMV, HIV, VZV, HBV, HCV
Co-morbidities
ABO 
anti-HLA Abs
Haplotype: HLA DR, A, B
XM
CI --> infection, Ca, co-morbidityies, failed pre implantation XM
31
Q

Immunosupression for renal Tx

A

Pre-op –> campath (anti CD52)

Post-op –> Steroids short term; tacrolimus/ciclosporin long term

32
Q

Transplant rejection

A

Hyperacute –> ABO incompatibility, thrombosis and SIRS
Acute –> <6mo; fever and graft pain, reduce UO, high Cr, immunosupression
Chronic –> >6mo; gradual increase in Cr, interstitial fibrosis, Rx supportive

33
Q

Immunospuression drug toxicity

A

Ciclosporin –> Calcineurin inhibitor (IL2 blocker). Nephrotoxic, hingival hypertrophy
Tacrolimus –> calcineurin inhibitor. DM, crdiomyopathy, neurotoxicity
Steroids

34
Q

Steel syndrome

A

Distal tissue ischaemia due to fistula

35
Q

Classifying CRF

A 
>90
60-89
30-59
16-29
<15
36
Q

Renal osteodystrophy: features

A

OP, OM, 2/3 HPT (subperiosteal bone resorption, acral osteolysis, pepperpot skull)
Osteosclerosis of the spine (Rugger Jersey spine)
Extraskeletal calcification

37
Q

Renal bone disease - Mx

A

Phosphate binders - calichew
Vit D analogues - alfacalciferol
Ca supplements

38
Q

UC Mx

A

MDT
Conservative: ADEK, high fibre, dietician review
Induction: 5ASA, pred (oral and PR), infliximab
Maintenance: 5ASA azathioprine, biologics
Surgical: Obstruction, megacolon, perforation, failure to respond to medical therapy

39
Q

CD Mx

A

Conservative: ADEK, high fibre, dietician review
Induction: budesonide/sulfasalazine; pred; methotrexate, biologics
Maintenance: azathioprine, methotrexate, biologics
Surgical: Obstruction, perforation, failure to respond to medical therapy

Final Prep (19 decks)

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