CCC - Liver and Renal 2 Flashcards
Which LFTs go up in obstructive jaundice?
ALP and GGT
Which LFTs go up in hepatitis?
ALT and AST
What goes up in pancreatic tumour?
Ca19-9
What does blood diarrhoea mean?
loss of epithelial integrity
What is DDx for bloody diarrhoea?
- infective colitis
- Inflammatory colitis: young, extra GI manifestations (uveitis)
- Ischamic colitis: elderly
- Diverticulitus, Malignancy
What organisms can cause infective colitis?
- Campylobacter
- Haemorrhagic E coli
- Entamoeba histrolytica
- Salmonella
- Shigella
How does UC show up on abdo xray?
ulcerative colitis: featureless abdo xray
lead pipe
How does toxic megacolon show on abdo xray?
(dilation>6cm), systemic illness (tachycardia, tachypnoea, fever)
What is the management of an acute GI bleed?
- ABC
- IV access (large bore cannulae)
- Fluids
- G&S, X-match blood
- OGD
What is the management of a Variceal bleed: e.g. chronic liver disease or varices?
- antibiotics
- terlipressin (causes vasoconstriction)
What are the investigations of an acute abdomen?
- FBC
- U+Es
- LFTs
- CRP
- Clotting
- G+Ss
- X match
- Erect CXR
- CT
What is the management of an acute abdoment?
- NBM
- fluids
- analgesic
- anti-emetics
- antibiotics
- monitor vitals and UO
What investigations do you do for a patient presenting with jaundice?
- Blood: FBC, LFTs, CRP
2. Abdominal USS: after a fast (gallstones better visualised in a distended, bile-filled gallbladder)
What investigations should you do with a patient presenting with dysphagia or weight loss?
- OGD
2. Biopsy
What investigation should you do with a patient presenting with PR bleed and weight loss?
colonoscopy
What is the management plan of a patient with ascites?
- Diuretics (spironolactone ± furosemide)
- Dietray sodium restriction
- fluid restriction in patients with hyponatraemia
- monitor weight daily
- therapeutic paracentesis (with IV human albumin)
How do you calculate ascites cause?
Serum albumin - ascites albumin
What may the cause of ascites be if albumin difference >11g/L?
cirrhosis (low albumin in ascites), cardiac failure (transudate)
What may the cause of ascites be if albumin difference <11g/L?
TB, Cancer, (nephrotic syndrome) - high level of protein in ascites (exudate)
What is the management of encephalopathy?
- lactulose: bacteria make ammonia so reducing transit time so less ammonia
- phosphate enema
What must you avoid and exclude in management of encephalopathy?
- Avoid sedation
- treat infections
- exclude a GI bleed
In post-op GI what are wound infection features?
- erythematosus
2. discharge
In post-op GI what are anastomotic leak features?
- diffuse abdo tenderness
- guarding, rigidity
- hypotensive/tachycardiac
In post-op GI what are pelvic abscess e.g. post-appendectomy features?
- pain
- fever
- sweats
- mucus
- diarrhoea
How do you manage a perianal abcess?
- tender red swelling
- incision and drainage
How do you manage anal fissure?
- rectal pain (defaecation)
- stool coated with blood
- advice re diet (fluids fibre)
- GTN cream
What is the presentation of IBS like?
- Reccurent abdo pain, bloating
- Improves with defecation
- Change in frequency/form of stool
- No PR bleed anaemia, weight loss or nocturnal symptoms, need to exclude coeliac
What is the treatment of IBS?
- Diet and lifestyle modification
- Symptomatic treatment
- Abdo pain: antispasmodics
- Laxative for constipation
- Anti-diarrhoeals
What are AKI features?
high urea and high creatinine
What are pre-renal causes of AKI?
- Hypovolaemia
2. Sepsis
What are renal cause of AKI?
glomerulonephritis (blood and protein in urine)
What are the post-renal causes of AKI?
- malignancy (prostate cancer)
- Abdominal USS
