Liver and Renal Flashcards
What are some signs of chronic liver disease on examination?
Asterexsis Brusing Clubbing Dupytrens Erythema (palmar) Fetor hepticus (breath smell) Gynaecomastia Itching (pruritus) Jaundice Spider Nevae Caput medusae Raised JVP AV fistulae (renal theraply)
What do you look for in the mouth?
Pigmentation Gum hypertrophy (medication post renal transplant can cause this)
What would a right subcostal scar be from?
BIliary surgery
Mercedes-benz scar?
Liver transplant
Midline lapartomy scar?
GI or major abdo surgery
Mcburneys incision?
Appendicetomy
J-shaped incision?
Renal transplant
Low transverse?
Gynae procedure
Inguinal incision?
Inguinal hernia repair and vascular access
Loin incision?
Nephrectomy
What are the causes of hepatomegaly?
Cancer Cirrhosis Cardiac - Congestive heart failure - Constrictive pericarditis
Infiltration
Summarise the causes of liver disesase
Alcohol Auto-immune Drugs Viral Biliary disease
What are the causes of splenomegaly?
2H and 2I
portal Hypertension
Haematological
Infection
Inflammation
What infections can cause splenomegaly?
EBV Infectious mononucleosis TB Malaria Infective endocarditis
What are gastro presentations?
Abdo pain Abdo distention Change of bowel habit GI bleed Jaundice Ascites
What is constant pain indicative of?
Inflammation
and -itis disease
What are some causes of epigastric pain?
What from the history can help differentiate?
Peptic ulcer (?NSAID use)
GORD (better with antaacids)
Gastritis (retrosternal, ETOH)
Malignancy
Acute pancreatitis (gallstones, high amylase)
Pain from above - cardiac
What are features of chronic pancreatitis?
Pain Wt loss loss of exocrine and endocrine function normal amylase faecal elastase
What are causes of RUQ pain?
Gallbladder:
Cholecystitis
Cholangitis
Gallstones
Liver:
Abscess
From above: basal pneumonia
Form left: peptic ulcer or pancreatitis
From right: pyelonephritis
What are causes of RIF pain?
Gynae:
Ovarian cyst rupture, twist, bleed
Ectopic pregnancy
GI Appendicitis Mesenteric adentis Colitis Malignancy
What are causes of suprapubic pain?
Cystisis
Urinary retention
What are causes of LIF pain?
GI
Diverticulitis
Colitis (IBD)
Malignancy
Gynae:
Ovarian cyst rupture, twist, bleed
Ectopic pregnancy
What are some causes of diffuse abdo pain?
Obstruction Infection - peritonitis, gastroenteritis IBD Mesenteric ischaemia Medical causes: DKA Addisons Hypercalcaemia Porphria Lead poisoning
What is porphyria?
Group of disorders caused by abnormalities in haem production
Can present with acute abdomen
What can cause abdominal distension?
Fluid
Flatus
Fat, faeces, fetus
What should you ask about when thinking about obstruction?
N and V Not opened bowel? High pitched tinkling bowel sounds Previous surgery - adhesions Tender irreducible hernia in the groin
What are the causes of transudate ascites?
High protein
- Cirrhosis
What causes pale stool?
Low stercobilinogen
What causes the different types of jaundice?
Pre-hepatic - haemolysis or defective bilirubin conjugation
Hepatic
Post-hepatic - biliary
What causes the different types of jaundice?
Pre-hepatic - haemolysis or defective bilirubin conjugation
Hepatic - hepatitis
Post-hepatic - biliary (pain), pancreatic cancer (painless)
When do you get dark urine?
Conjugated bilirubin leaks and makes it way into urine in hepatitis
Does not enter bowel so pale stools. Obstruction to flow.
Why does bloody diarrhoea happen?
Loss of epithelial integreity
What are the infective causes of bloody diarrhoea?
Infective colitis
- Campylobacter
- Haemorrhagic e. coli
- Entamoeba histo
- S
- S
What is thumb print sign?
Thickening of bowel
Thick haustral folds
What is the lead pipe sign?
UC
What is toxic megacolon?
Dilated colon more than 6cm with systemic signs
How is a acute GI bleed managed?
ABC IV access Fluids G+S, X match OGD
How is a variceal bleed from chronic liver disease treated?
ABs
Terlipressin
What is the mangement of acute abdomen?
NBM Fluids Analgesic Anti-emetics Antibiotics Monitor vitals
What investigations for jaundiced patients?
FBC, LFTs, CRP
Abdo USS after fast
What is the management for ascites?
Diuretics NA restriction Fluid restriction Monitor weight daily Therapeutic paracentesis
