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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
What ascites neutrophil level is characteristic of spontaneous bacterial peritonitis?
≥250 cells/mm³
26
What are the causes of abdominal distension? (x5)
Fat, fluid, faeces, flatus, foetus
27
What kind of bowel sounds are heard in obstruction?
High pitched, tinkling
28
What are the ways you can classify ascites?
1. Low vs. high albumin gradient | 2. Transudate vs. exudate
29
What is meant by a low albumin gradient and what are some causes?
Serum - ascites albumin gradient <11g/L 1. TB 2. Nephrotic Syndrome 3. Cancer 4. Peritonitis 5. Pancreatitis
30
What is meant by a high albumin gradient and what are some causes?
Serum - ascites albumin gradient >11g/L 1. Portal HTN 2. Cirrhosis 3. Cardiac failure (acute + chronic) 4. Constrictive pericarditis
31
What are the transudate causes of ascites?
Cirrhosis, Cardiac failure, Nephrotic Syndrome
32
What are the exudate causes of ascites?
1. Malignancy (abdo, pelvis, peritoneal mesothelioma) 2. Infection (TB, pyogenic) 3. Budd-Chiari syndrome (hepatic vein thrombosis) 4. Portal vein thrombosis
33
How can you classify the causes of jaundice?
Pre-hepatic, hepatic, post-hepatic
34
What are the pre-hepatic causes of jaundice?
Haemolysis or defective conjugation (Gilbert's syndrome) --> high unconjugated bilirubin
35
What causes Gilbert's syndrome?
Mutation in the UGT1A1 gene that leads to decreased activity of uridine diphosphate glucuronosyltransferase, with subsequent reduction in glucorinidation
36
What is the path of bilirubin synthesis, conjugation, and excretion in the body?
RBC → Spleen → RBC breakdown → unconjugated bilirubin → liver (UDPGT) → conjugated bilirubin (water soluble) → bile → bowel → urobilinogen → stercobilinogen (brown)
37
What are the hepatic causes of jaundice?
Hepatitis = alcohol, autoimmune, drugs, viruses
38
Why do you get dark urine with hepatic jaundice?
Hepatocellular damage causes conjugated bilirubin to leak out → dark urine
39
What are the post-hepatic causes of jaundice?
1/3rd gallstones, 1/3rd pancreas, 1/3rd other
40
What are the 'other' causes of post-hepatic jaundice?
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
What are the features of post-hepatic jaundice?
High conjugated bilirubin, pale stool (low stercobilinogen), dark urine (leaking conjugated bilirubin)
42
What is the tumour marker for pancreatic cancer?
Ca 19-9
43
What is Trousseau's sign of malignancy?
Migratory thrombophlebitis most commonly due to adenocarcinomas of the lung and pancreas, and gliomas
44
What are the causes of bloody diarrhoea?
``` Infective colitis = CHESS Inflammatory colitis = IBD Ischaemic colitis Diverticulitis Malignancy ```
45
What does thumb-printing on an AXR mean?
Inflammation in the wall of the bowel e.g. IBD
46
What does a lead-pipe on AXR mean?
IBD
47
What is the AXR cut-off for a toxic megacolon?
>6cm
48
What is the management of a variceal bleed?
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
What is the management of ascites?
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
What is the management of hepatic encephalopathy?
1. Lactulose + phosphate enemas | 2. Avoid sedation, treat infections, exclude a GI bleed
51
What are 3 common post-operative surgical complications?
1. Wound infection 2. Anastomotic leak 3. Mucus diarrhoea

Medicine and Surgery Mushkies (52 decks)

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