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Medicine and Surgery Mushkies > General Internal Mushkies > Flashcards

General Internal Mushkies Flashcards

1
Q

What are the causes of hepatomegaly?

A

3Cs, 2Is, 2Bs

  1. Cancer = primary or secondary
  2. Cirrhosis = early, usually alcoholic
  3. Cardiac = CCF, congestive pericarditis
  4. Infiltration = fatty, haemochromatosis, amyloidosis, sarcoidosis
  5. Infection = Viral, Malaria, Abscess
  6. Blood = leukaemia, lymphoma, myeloproliferative, haemolytic
  7. Biliary = PBC, PSC
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2
Q

What is are the signs of hepatic failure?

A 
Asterixis 
Bruising
Clubbing 
Dupuytren's contracture
Erythema (palmar)
Foetor 
Gynaecomastia 
Hair loss 
Icterus 
Jaundice
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3
Q

How can you classify the causes of liver disease?

A
  1. Alcohol
  2. Autoimmune
  3. Drugs
  4. Viral
  5. Biliary Disease
  6. Metabolic
  7. Malignancy
  8. Vascular
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4
Q

What are the causes of splenomegaly?

A

2Hs, 2Is

  1. Haematological = lymphoma, leukaemia, myelofibrosis, haemolytic anaemia
  2. Portal HTN
  3. Infection = EBV, IE, malaria
  4. Inflammation = amyloidosis/sarcoidosis
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5
Q

What are the causes of epigastric pain?

A
  1. Stomach (peptic ulcer, GORD, gastritis, malignancy)
  2. Pancreas (acute pancreatitis)
  3. Right = Hepatitis/cholesystitis
  4. Above = MI
  5. Below = AAA
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6
Q

What is a faecal marker that is a sign of chronic pancreatitis?

A

Low faecal elastase

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7
Q

What are the features of chronic pancreatitis?

A
  1. Pain
  2. Weight loss
  3. Loss of exocrine function –> steatorrhoea
  4. Loss of endocrine function –> diabetes
  5. Normal amylase
  6. Low faecal elastase
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8
Q

What are the causes of RUQ pain?

A
  1. Gallbladder = colic, cholecystitis, cholangitis
  2. Liver = hepatitis, abscess
  3. Above = basal pneumonia
  4. Below = appendicitis
  5. Left = stomach/pancreas
  6. Right = pyelonephritis
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9
Q

What are the causes of RIF pain?

A
  1. GI = appendicitis, mesenteric adenitis, colitis (IBD), malignancy, Meckel’s diverticulum
  2. Gynaecological = ovarian cyst rupture/torsion/bleed, ectopic pregnancy
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10
Q

What are the causes of suprapubic pain?

A

Cystitis or UTI

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11
Q

What are the causes of LIF pain?

A
  1. GI = diverticulitis, colitis (IBD), malignancy

2. Gynaecological = ovarian cyst rupture/torsion/bleed, ectopic pregnancy

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12
Q

What are the causes of diffuse abdominal pain?

A
  1. Obstruction
  2. Infection = peritonitis, gastroenteritis
  3. Inflammation = IBD
  4. Ischaemia = mesenteric ischaemia
  5. Medical = DKA, Addison’s, hypercalcaemia, Porphyria, Lead poisoning
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13
Q

How does mesenteric ischaemia present?

A

Pain after eating

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14
Q

How does porphyria present?

A

Abdominal pain
Vomiting
Weak handshake
Red/purple urine

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15
Q

At what levels do the Coeliac artery, SMA and IMA come off the abdominal aorta?

A 
Coeliac = T12
SMA = L1 
IMA = L3
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16
Q

What does the coeliac trunk supply? (x5)

A

Stomach, spleen, liver, gallbladder, duodenum

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17
Q

What does the SMA supply?

A

Small Intestine + Right Colon

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18
Q

What does the IMA supply?

A

Left colon

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19
Q

What connects the Coeliac trunk to the SMA?

A

Pancreaticoduodenal arcade

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20
Q

What connects the SMA to the IMA?

A

The Arc of Riolan and the Marginal Artery of Drummond

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21
Q

What are the branches of the coeliac artery?

A
  1. Left gastric artery
  2. Common hepatic artery
  3. Splenic artery
22
Q

What are the branches of the SMA?

A
  1. Inferior pancreaticoduodenal artery
  2. Intestinal branches (jejunal, ileal)
  3. Ileocolic artery
  4. Right colic artery
  5. Middle colic artery
23
Q

What are the branches of the IMA?

A
  1. Left colic artery
  2. Sigmoid branches
  3. Superior rectal artery
24
Q

What are the signs of decompensated liver disease?

A

JEA
Jaundice
Encephalopathy
Ascites

25
Q

What ascites neutrophil level is characteristic of spontaneous bacterial peritonitis?

A

≥250 cells/mm³

26
Q

What are the causes of abdominal distension? (x5)

A

Fat, fluid, faeces, flatus, foetus

27
Q

What kind of bowel sounds are heard in obstruction?

A

High pitched, tinkling

28
Q

What are the ways you can classify ascites?

A
  1. Low vs. high albumin gradient

2. Transudate vs. exudate

29
Q

What is meant by a low albumin gradient and what are some causes?

A

Serum - ascites albumin gradient <11g/L

  1. TB
  2. Nephrotic Syndrome
  3. Cancer
  4. Peritonitis
  5. Pancreatitis
30
Q

What is meant by a high albumin gradient and what are some causes?

A

Serum - ascites albumin gradient >11g/L

  1. Portal HTN
  2. Cirrhosis
  3. Cardiac failure (acute + chronic)
  4. Constrictive pericarditis
31
Q

What are the transudate causes of ascites?

A

Cirrhosis, Cardiac failure, Nephrotic Syndrome

32
Q

What are the exudate causes of ascites?

A
  1. Malignancy (abdo, pelvis, peritoneal mesothelioma)
  2. Infection (TB, pyogenic)
  3. Budd-Chiari syndrome (hepatic vein thrombosis)
  4. Portal vein thrombosis
33
Q

How can you classify the causes of jaundice?

A

Pre-hepatic, hepatic, post-hepatic

34
Q

What are the pre-hepatic causes of jaundice?

A

Haemolysis or defective conjugation (Gilbert’s syndrome) –> high unconjugated bilirubin

35
Q

What causes Gilbert’s syndrome?

A

Mutation in the UGT1A1 gene that leads to decreased activity of uridine diphosphate glucuronosyltransferase, with subsequent reduction in glucorinidation

36
Q

What is the path of bilirubin synthesis, conjugation, and excretion in the body?

A

RBC → Spleen → RBC breakdown → unconjugated bilirubin → liver (UDPGT) → conjugated bilirubin (water soluble) → bile → bowel → urobilinogen → stercobilinogen (brown)

37
Q

What are the hepatic causes of jaundice?

A

Hepatitis = alcohol, autoimmune, drugs, viruses

38
Q

Why do you get dark urine with hepatic jaundice?

A

Hepatocellular damage causes conjugated bilirubin to leak out → dark urine

39
Q

What are the post-hepatic causes of jaundice?

A

1/3rd gallstones, 1/3rd pancreas, 1/3rd other

40
Q

What are the ‘other’ causes of post-hepatic jaundice?

A
  1. Lymph nodes at Porta Hepatis = TB, Ca
  2. Inflammatory = PBC, PSC
  3. Drugs = OCP, sulfonylureas, flucloxacillin
  4. Neoplastic = Cholangiocarcinoma
  5. Mirizzi’s syndrome
41
Q

What are the features of post-hepatic jaundice?

A

High conjugated bilirubin, pale stool (low stercobilinogen), dark urine (leaking conjugated bilirubin)

42
Q

What is the tumour marker for pancreatic cancer?

A

Ca 19-9

43
Q

What is Trousseau’s sign of malignancy?

A

Migratory thrombophlebitis most commonly due to adenocarcinomas of the lung and pancreas, and gliomas

44
Q

What are the causes of bloody diarrhoea?

A 
Infective colitis = CHESS
Inflammatory colitis = IBD
Ischaemic colitis
Diverticulitis
Malignancy
45
Q

What does thumb-printing on an AXR mean?

A

Inflammation in the wall of the bowel e.g. IBD

46
Q

What does a lead-pipe on AXR mean?

A

IBD

47
Q

What is the AXR cut-off for a toxic megacolon?

A

> 6cm

48
Q

What is the management of a variceal bleed?

A
  1. ABCDE + Fluids, G&S + X match blood
  2. OGD to find underlying cause
  3. Abx (Tazocin, ciprofloxacin)
  4. Terlipressin (causes splanchnic vasoconstriction, dont give to a peptic ulcer pt)
49
Q

What is the management of ascites?

A
  1. Diuretics (spironolactone +/- furosemide)
  2. Ascitic tap (to rule out SBP)
  3. Dietary Na restriction + fluid restriction in pts w/ hyponatraemia
  4. Monitor weight daily + therapeutic paracentesis (w/ 20% human albumin)
50
Q

What is the management of hepatic encephalopathy?

A
  1. Lactulose + phosphate enemas

2. Avoid sedation, treat infections, exclude a GI bleed

51
Q

What are 3 common post-operative surgical complications?

A
  1. Wound infection
  2. Anastomotic leak
  3. Mucus diarrhoea

Medicine and Surgery Mushkies (52 decks)

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