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Finals Revision Progress > Medical Abdo > Flashcards

Medical Abdo Flashcards

1
Q

Causes of chronic liver disease?

A

Common causes:

  • Alcohol
  • Chronic hepatitis (B/C)
  • NAFLD

Additional causes can be classified into Vascular, AI, genetic and drugs

Vascular: Budd-Chiari
AI: PBC and PSC
Congenital: Wilson’s, hereditary haemochromatosis
Drugs: methotrexate, isoniazid

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2
Q

Complications of cirrhosis?

A

CAVES

Coagulopathy
Ascites
Varices
Encephalopathy
Sepsis/SBP
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3
Q

Ix for CLD?

A

Bloods:

  • Basic plus INR
  • Liver screen (includes alcohol, viral serology and AI Abs)
  • Ascitic tap

Imaging:

  • Liver USS
  • –> “Fibroscan” allows you to grade cirrhosis

Maybe liver biopsy

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4
Q

What is encephalopathy? Way to score it?

A

Metabolic function of liver breaks down so toxins go into systemic system, ammonia accumulates in brain and metabolises to glutamine, causing cerebral oedema.

Score using West Haven scoring system

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5
Q

How would you complete your examination if suspecting decompensated liver disease?

A

External genitalia: look for testicular atrophy

DRE: Look for malaena suggesting upper GI bleed

Urine dip: look for potential urosepsis which can cause decompensation

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6
Q

Precipitants of decompensation?

A

HEPATICS

Haemorrhage
Electrolyte disturbance
Poisons (diuretics, anaesthetics)
Alcohol
Tumour
Infection
Constipation 
Sugar low
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7
Q

Reasons for liver transplant?

A

Cirrhosis
Liver failure secondary to Hep A/B, paracetamol overdose
Malignancy

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8
Q

Causes of hepatomegaly

A

3 Cs, 3 Is

Carcinoma
CCF
CLD

Infection (hepatitis)
Immune (hepatitis)
Infiltrative (sarcoidosis)

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9
Q

Causes of hepatosplenomegaly

A

CCF
Viral hepatitis
Portal hypertension

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10
Q

What are the causes of portal HTN?

A

Cardiovascular causes:
Portal vein thrombosis
Budd Chiari (hepatic vein thrombosis)
Right heart failure

Hepatic:
Cirrhosis

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11
Q

Causes of splenomegaly

A

CHINA

Congestive: portal hypertension, CCF
Haem: sickle cell, haemolytic anaemia
Infection: Malaria, leishmaniasis, EBV
Neoplasm: myelofibrosis, leukaemia and lymphomas
Autoimmune: Felty’s, sarcoidosis, amyloid

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12
Q

How might CML present? What chromosome is associated? How is it treated?

A

FLAWS
Massive splenomegaly
Bruising/bleeding
Hyperviscosity

Philadelphia chromosome t(9:22)

Tx: Imatinib (tyrosine kinase inhibitor)

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13
Q

What vaccinations are required after splenectomy? Any other precautions?

A

Pneumococcal
Meningococcal
Hib

Daily Pen V
Carry an alert card

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14
Q

Causes of enlarged kidneys?

A 
Bilateral
ADPKD
Bilateral RCC
Bilateral cysts
Hydronephrosis

Unilateral:
Renal RCC
Hydronephrosis
Simple renal cysts

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15
Q

Complications of chronic renal failure?

A

CRF HEALS

CVD
Renal osteodystrophy
Fluid overload
HTN
Electrolyte disturbance 
Anaemia 
Leg restlesness
Sensory neuropathy
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16
Q

What are the indications for renal replacement therapy?

A

Sx affecting QOL
Fluid overload
GFR 5-7 ml/min without symptoms
GFR 15ml/min with symptoms

Tx resistant:
HyperK
Acidosis

17
Q

Complications of dialysis?

A

CRAMI

CVD
Renal cysts
Amyloidosis
Malnutrition
Infection
18
Q

criteria used to diagnose an acute severe exacerbation of IBD? o

A

True-Love and Witts Criteria

Takes into account symptoms, systemic signs, lab values.

19
Q

Management of UC?

A

5PC - 5AI

Induction:

  1. 5 ASAs
  2. Prednisolone
  3. Ciclosporin/ infliximab

Maintenance:

  1. 5 ASAs
  2. Azathioprine
  3. Infliximab
20
Q

Management of Crohns?

A

CAMI

Corticosteroids (e.g. budesonide, prednisolone)
Azathioprine
Methotrexate
Infliximab

21
Q

AXR findings in UC or Crohn’s?

A

UC - toxic megacolon

Crohns: strictures and bowel obstruction

22
Q

Difference in inflammation between UC and CD?

A

UC: Rectum and colon; may have backwash ileitis
Mucosal inflammation, continuous

CD: Mouth to anus, esp terminal ileum
Skip lesions, cobblestone mucosa, transmural, fistulae and strictures

23
Q

Extra intestinal features of IBD

A

A PIE SAC

Apthous ulcers
Pyoderma gangrenosum (UC)
Iritis
Erythema nodosum
Sacroileitus
Arthritis
Clubbing
24
Q

Von hippel Lindau

A

Autosomal dominant, predisposes to cysts neoplasia in multiple organs, such as;

“PH BAKE”

Pancreas
Hepatic
Brain
Adrenals
Kidneys
Eyes
25
Q

Types of renal cell carcinoma and classic presentation?

A

Clear cell

Triad:
Haematuria
Loin pain
Loin mass

26
Q

Immunosuppressive drugs used after renal transplant? Side effects?

A

Ciclosporin: calcineurin inhibitor

  • Nephrotoxic
  • Gum hypertrophy

Tacrolimus: calcineurin inhibitor
- Neurotoxic

27
Q

Commonest indications for renal transplant?

A 
Diabetic nephropathy
Glomerulonephritis
PKD
Hypertensive nephropathy
NOT CANCER
28
Q

Types of rejection with renal transplant

A

Hyperacute (minutes)
Acute (<6mo)
Chronic (>6mo)

29
Q

Indications for dialysis in AKI and generally

A

generally, when GFR <15ml/min +symptoms , or <7ml/min without symptoms

in AKI:
AEIOU

Acidosis
Electrolyte
Intoxication
Overload
Uraemia
30
Q

Features of CKD?

A

BIG BEAN

Breathlessness
Itching
Gout
Bone pain
Energy levels low
Anaemia
Neuropathy
31
Q

Mechanism of peritoneal dialysis

A

Dialysate infused into peritoneal cavity by Tenchkhoff catheter

Uraemia solutes diffuse into fluid across peritoneum

Approximately 3L 4x a day with 4 hour dwell times

32
Q

Complications of dialysis

A

Line related: infection, peritonitis, catheter malfunction

General:

  • disequilibrium syndrome (first time) causing cerebral oedema
  • fluid balance problems, i.e. BP
  • Infection
  • Amyloidosis
  • Renal cysts
  • Tiredness, reduced QOL
33
Q

Types of fistula and location

A

Brachio-cephalic @ elbow

Radio-cephalic @ wrist

34
Q

Fistula advantages and disadvantages

A

Pros:

  • High flow rates
  • Low infection rates
  • Less chance of stenosis

Cons:

  • Takes 6 weeks to arterialise
  • Body image, psychosocial
  • Cannot take blood/BP
35
Q

PBC; what is it and what antibodies? Tx?

A
  • Intrahepatic bile ducts become damaged by a chronic granulomatous inflammation; may progress to cirrhosis.
  • itching in a middle-aged woman

Abs:

  • anti-mitochondrial antibodies (AMA)
  • smooth muscle antibodies in 30% of patients

Tx:

  • Ursodeoxycholic acid
  • Vitamins, liver transplant
36
Q

PSC: what is it and what antibodies?

A

characterised by inflammation, strictures fibrosis of intra AND extra-hepatic bile ducts, associated with IBD, mainly UC

May be c-ANCA positive, biopsy might show onion skinning

37
Q

Types of fatty liver disease?

A

Types:

  • NAFLD (obesity)
  • Alcoholic fatty liver (leading to alcoholic liver disease
  • Acute fatty liver (pregnancy, drugs)
38
Q

What is NAFLD? What is mainstay of treatment?

A

4 Stages of NAFLD

  • Slightly fatty, no Sx
  • NASH
  • Fibrosis
  • Cirrhosis

Tx: weight loss and CV risk factors

Finals Revision Progress (16 decks)

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