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Z Year 3 Misc > CCC - Liver and Renal > Flashcards

CCC - Liver and Renal Flashcards

1
Q

What can comes up is OSCE abdo?

A
  • Chronic Liver Disease
  • Chronic Kidney Disease
  • Haematology clinic
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2
Q

What is the ABCDEFGHIJ for abdo?

A 
Asterixs (flap)
Brusing (clotting factors made in liver) 
Clubbing
Dupytrens
Erythhema (palmar)         
Fetor hepaticus
Gyanecomastia
Hair loss
I
Jaundice
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3
Q

What features do you look for in the hands?

A
  1. Asterixs (flap)
  2. Brusing (clotting factors made in liver)
  3. Clubbing
  4. Dupytrens
  5. Erythhema (palmar)
  6. Leuconychia
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4
Q

What features do you look for in the forearms?

A
  1. av fistulae

2. current or previous renal replacement therapy

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5
Q

What features do you look for in the head and neck?

A
  1. anaemia
  2. jaundice
  3. Skin: jaundice, excoriation marks or spider naevi
  4. Oral examination: pigementation, gum hypertrophy
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6
Q

Why might there be gum hypertrophy?

A

on ciclosporine after renal transplant

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7
Q

What do you look for on chest inspection?

A
  1. Gynaecomastia
  2. Hair loss
  3. Excoriation marks
  4. Spider naevi
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8
Q

What do you look for on abdominal inspection?

A
  1. Abdominal distension?
  2. Caput medusae?
    - distended superficial abdominal veins
    - direction of flow in the veins below the umbilicus is towards the legs
  3. Scars?
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9
Q

What would a right subcostal scar suggest?

A

biliary surgery

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10
Q

What would a mercedes-benz incision suggest?

A

liver transplant

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11
Q

What would a midline laparomotmy scar suggest?

A

GI or any major abdominal surgery

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12
Q

What would a McBurney’s incision suggest?

A

appendicetomy

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13
Q

What would a J shaped incision suggest?

A

renal transplant

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14
Q

What would a low transverse incision suggest?

A

gynae procesdure

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15
Q

What would an inguinal incision suggest?

A

hernia repair, vascular access

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16
Q

What would a loin incision suggest?

A

nephroectomy

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17
Q

What are the causes of hepatomegaly?

A
  1. Cancer: primary or secondary deposits
  2. Cirrhosis (early, usually alcoholic)
  3. Cardiac:
    - congestive cardiac failure
    - constrictive pericarditis
  4. Infiltration
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18
Q

What are the infiltration causes of hepatomegaly?

A
  1. fatty infilatration
  2. haemochromatosis
  3. amyloidosis
  4. sarcoidosis
  5. lymphoproliferative diseases
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19
Q

What are the causes of liver disease?

A
  1. alcohol
  2. autoimmune
  3. drugs
  4. viral
  5. biliary disease
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20
Q

What are the causes of splenomegaly?

A
  1. H (portal Hypertension) - chronic liver disease
  2. H (haematological) - haemolytic anaemia
  3. Infection: infectious mononucleosis, TB, IE, malaria
  4. Inflammation:
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21
Q

If abdominal pain is constant what does it suggest?

A

inflammation

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22
Q

If abdominal pain is colicky what does it suggest?

A

obstruction

23
Q

What are epigastric pain DDx?

A
  • Stomach:
    1. peptic ulcer (NSAID use?)
    2. GORD (better with antacids)
    3. Gastritis (retosteronal, alcohol)
    4. Malignancy
  • Pancreas
    1. acute pancreatitis (Hx of gallstones? high amylase?)
24
Q

What are surrounding epigastric pain DDx?

A
  • Above: (heart) MI
  • Below: (aorta) ruptured aortic aneurysm
  • Right: (liver/gallbladder) cholecystitis, hepatitis
25
Q

What is acute pancreatitis associated with?

A
  1. pain

2. v high amylase

26
Q

What is chronic pancreatitis associated with?

A
  1. chronic pain
  2. weight loss
  3. loss of exocrine function (malabsoprtion)
  4. loss of endocrine function (diabetes)
  5. normal amylase
  6. faecal elastase (in stool sample)
27
Q

What are the RUQ pain DDx?

A
  • Gallbladder:
    1. cholecystitis
    2. cholangitis
    3. gallstones
  • Liver:
    1. hepatitis
    2. abscess
28
Q

What are the surrounding RUQ pain DDx?

A
  1. Above: (lungs) basal pneumonia
  2. Below: (appendix) appendicitis
  3. Left: (stomach, pancreas) peptic ulcer, pancreatitis
  4. Right: (kidney) pyelonephritis
29
Q

What are RIF pain DDx?

A
  • GI:
    1. Appedicitis
    2. Mesenteric adenitis (common in children)
    3. Colitis (IBD)
    4. Malignancy
  • Gynae:
    1. Ectopic pregnancy
    2. Ovarian cyst rupture, twist, bleed
30
Q

What are suprapubic pain DDx?

A
  1. cystitis

2. urinary retention

31
Q

What is LIF pain DDx?

A
  • GI:
    1. Diverticulitis
    2. Colitis (IBD)
    3. Malignancy
  • Gyanecological:
    1. ovarian cyst rupture, twist, bleed
    2. ectopic pregnancy
32
Q

What are diffuse abdominal pain DDx?

A
  1. obstruction
  2. infection: peritonitis, gastroenteritis
  3. inflammation: IBD
  4. ischaemic: mesenteric ischaemia
33
Q

What are medical causes of diffuse abdominal pain?

A
  1. DKA
  2. Addison’s
  3. Hypercalacemia
  4. Porphyria
  5. Lead poisoning
34
Q

What does the celiac artery supply?

A
  1. Stomach
  2. Spleen
  3. Liver
  4. gallbladder
  5. Dudoenum
35
Q

What does the superior mesenteric artery supply?

A
  1. small intestine

2. right colon

36
Q

What does the inferior mesenteric artery supply?

A

left colon

37
Q

What do the iliac arteries supply?

A

rectum

38
Q

When is amylase high?

A

in any acute abdominal pathology - esp high in acute pancreatitis

39
Q

When is lactate high?

A

problem with perfusion (ischaemia)

40
Q

When is bicarbonate low?

A

metabolic acidosis

41
Q

What is SBP?

A

spontaneous bacterial peritonitis - complication of liver disease

42
Q

What is the ascites neutrophil count like in SBP?

A

> 250cells/mm^3 (need antibtioics)

43
Q

What are causes of abdominal distension?

A
  1. Fluid
  2. Flatus
  3. Fat
  4. Feaces
  5. Fetus
  6. F big tumour
44
Q

What may cause fluid abdominal distention?

A

Ascites:

  • shifting dullness
  • features of liver disease
45
Q

What may cause flatus abdominal distension?

A

Obstruction:

  • nause and vomiting
  • not opened bowel
  • high pitched tinkling bs
  • previous surgery (adhesions) ?
  • tender irreducible femoral hernia in groin ?
46
Q

What are transudate causes of ascites?

A
  1. cirrhosis
  2. cardiac failure
  3. nephrotic syndrome
47
Q

What are the exudate causes of ascites?

A
  1. malignancy (abdominal, pelvic, peritoneal mesothelioma)
  2. infection e.g. TB, pyogenic
  3. Budd-Chiari syndrome (hepatic vein thrombosis), portal vein thrombosis
48
Q

What are three causes of jaundice and examples?

A
  1. prehepatic: haemolysis, defective conjugation
  2. hepatic: hepatitis
  3. post-hepatic: CBD obstruction
49
Q

What are causes of pre-hepatic jaundice?

A
  1. haemolysis

2. gilbert’s syndrome

50
Q

What is the mechanism of pre-hepatic jaundice?

A

decreased glucuronidation so increased unconjugated bilirubin

51
Q

What is the mechanism of hepatocellular jaundice?

A

conjugated bilirubin leaks out of hepatocytes and loose in urine so dark urine

52
Q

What is the mechanism of post-hepatic jaundice?

A

conjugated bilirubin leaks out hepatocytes giving dark urine

not getting to large bowel have decreased stercobilinogen so pale stool

53
Q

What does dark urine and pale stool suggest?

A

post-hepatic jaundice

Z Year 3 Misc (11 decks)

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