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VIVAs > GI/Renal > Flashcards

GI/Renal Flashcards

1
Q

What is acute liver failure and what are the subtypes?

A

occurrence of encephalopathy, coagulopathy & jaundice in an individual with previously normal liver function or well-compensated liver disease

Subtypes:
hyperacute - within a week of onset of jaundice
acute - within 2-4 weeks post onset of jaundice
subacute - >4 weeks post onset of jaundice

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2
Q

What are causes of acute liver failure?

A
  • toxicity eg paracetamol overdose
  • Acute viral hepatitis
  • Alcoholic hepatitis
  • Acute Fatty liver of pregnancy
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3
Q

What are clinical features of acute liver failure on history?

A
  • nausea, vomiting, agitation, abdominal pain
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4
Q

What are clinical features of acute liver failure on exam?

A
  • jaundice
  • encephalopathy
  • Ascites
  • Septic shock/hypotension
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5
Q

What are Ix in acute liver failure?

A
  • FBE - high WCC in infective/inflammatory cause
  • Coags
  • BSL - risk of hypoglycaemia
  • UEC - renal impairment
  • Ammonia
  • Paracetamol level
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6
Q

What are the main two types of chronic liver disease?

A

Chronic hepatitis
Cirrhosis

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7
Q

What are the causes of chronic liver disease?

A

Chronic hepatitis - HCV, HBV, autoimmune, drug induced

Cirrhosis - alcohol, HCV, HBV, drugs

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8
Q

What are clinical features of chronic liver failure on history?

A

fatigue, pruritis, bleeding, abdominal pain, nausea, anorexia,
myalgia, jaundice, dark urine, pale stools, fever, weight loss

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9
Q

What are clinical features of chronic liver failure on exam?

A

o Hands – leuconychia, clubbing, palmar erythema, bruising, asterixis
o Face – jaundice, scratch marks, spider naevi, fetor hepaticus
o Chest – gynaecomastia, loss of body hair, spider naevi, bruising, pectoral muscle wasting
o Abdomen – hepatosplenomegaly, ascites, signs of portal hypertension (splenomegaly, collateral veins /
haematemesis from oesophageal or gastric varices, ascites), testicular atrophy
o Legs – oedema, muscle wasting, bruising
o Fever – occurs in up to 1/3 of patients with advanced cirrhosis or if there is infected ascites

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10
Q

What are Ix for chronic liver failure?

A
  • Bilirubin (normal <20)
  • FBE - anaemia, thrombocytopaenia
  • Coag
  • Synthetic function - albumin, INR, glucose
  • Liver injury - ALT, AST, ALP, GGT
  • Liver USS - ultrasound, portal hypertension
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11
Q

What is used to calculate child pugh classification?

A

AABIE

Albumin, ascites
Bilirubin
INR
Encephalopathy

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12
Q

What is the periop mortality for child pugh A, B, C?

A

A = <5%
B = 5-50%
C = >50%

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13
Q

What are some complications of chronic liver disease?

A

Liver:
- Ascites
- Portal hypertension

Cardiac:
- Hyperdynamic circulation (high CO, low SVR)
- Cirrhotic cardiomyopathy

Resp:

  • Portopulmonary hypertension
  • Hepatopulmonary syndrome

Renal:
- Hepatorenal syndrome

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14
Q

What are some anaesthetic implications of chronic liver disease?

A

A - aspiration risk due to delayed gastric emptying
B - Ascites can cause restrictive lung disease
C - Check coags, risk of hyperdynamic circulation

Altered pharmacology

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15
Q

What is Haemochromatosis ?

A

Autosomal recessive disorder that disrupts the body’s regulation of iron & is characterised by increased accumulation of iron in various organs

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16
Q

What are the possible complications of haemochromatosis?

A
  • liver cirrhosis
  • diabetes (pancreatic fibrosis)
  • Cardiac iron deposition (heart failure, conduction abnormalities, coronary atherosclerosis)
17
Q

What are some implications of haemochromatosis?

A
  • Check that ferritin is low end of normal (delay if high and treat)
  • Check coagulation
  • Check for cardiac, liver, pancreatic impairment and anaethetise accordingly (avoid myocardial depressents if cardiac failure etc.)
18
Q

What is Wilson’s disease?

A

Inherited disease (autosomal recessive) of copper metabolism dysfunction characterised by cirrhosis & central nervous system findings

19
Q

What organs are often affected by Wilson’s disease?

A

Liver - cirrhosis
Brain
Kidney
Cardiac - cardiomyopathy, rhythm abnormalities

20
Q

What are important features on history for wilson’s disease?

A
  • Multisystem involvement, liver, brain, kidney, cardiac
  • Pinicillamine side effects (myasthenia like syndrome) from chelating agents used to prevent damaged from copper
21
Q

What are some anaesthetic implications of wilson’s disease?

A
  • exclude coagulopathy
  • continue chelating agent therapy
  • monitor for liver dysfunction and treat accordingly
  • care with NMB with myasthenia like syndrome
22
Q

What are common causes of CKD?

A
  • Diabetic nephropathy
  • HTN
  • Glomerulonephritis
  • obstructive nephropathies
  • Autoimmune
23
Q

What are common features on history for CKD?

A
  • Cause and course of CKD
  • Uraemic symptoms to assess adequacy of dialysis - anorexia, nausea, vomiting, pruritis, oedema
  • Modality of RRT if on it
  • Access for RRT
  • Dry weight, last time dialysed
  • Fluid restriction
  • Urine output
  • Sx of fluid overload eg PND, orthopnoea
  • IHD features
24
Q

What are common features to look for on examination in CKD?

A

General:
- mental state, pallor, scratch marks
- Assess volume status - mucous membranes, postural hypotension, tachycardia, oedema, weight gain, increased JVP
- Site of RRT access eg fistula

Cardiac:
-Signs of cardiac failure
- Pericarditis eg rub

Resp:
- chest creps
- pleural effusions

Abdomen:
- ascites

25
Q

What Ix would you look at for CKD?

A

Bloods:
-eGFR
- creat
- electrolytes incl urea
- coag studies
- FBE - anaemia

ECG
- signs of hyperkalaemia

26
Q

What are features to optomise for CKD patients?

A
  • Volume status
  • Anaemia
  • Electrolytes incld K <5.5 on day of surgery
  • Dialysis 24hrs prior to theatre
27
Q

What are the RIFLE criteria?

A

Highly sensitive interim staging system for AKI based on data that a small change in serum Cr influences outcome
o Risk of renal dysfunction (1.5x creat or UO <0.5mls/kg/hr for 6hrs)
o Injury to the kidney (2x creat or UO <0.5mls/kg/hr for 12hrs)
o Failure of kidney function (3x creat or UO <0.5mls/kg/hr for 24hrs)
o Loss of kidney function >4 weeks
o End-stage kidney disease > 3months

VIVAs (7 decks)

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