Medical Abdo Flashcards
Causes of chronic liver disease?
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
Complications of cirrhosis?
CAVES
Coagulopathy Ascites Varices Encephalopathy Sepsis/SBP
Ix for CLD?
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
What is encephalopathy? Way to score it?
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
How would you complete your examination if suspecting decompensated liver disease?
External genitalia: look for testicular atrophy
DRE: Look for malaena suggesting upper GI bleed
Urine dip: look for potential urosepsis which can cause decompensation
Precipitants of decompensation?
HEPATICS
Haemorrhage Electrolyte disturbance Poisons (diuretics, anaesthetics) Alcohol Tumour Infection Constipation Sugar low
Reasons for liver transplant?
Cirrhosis
Liver failure secondary to Hep A/B, paracetamol overdose
Malignancy
Causes of hepatomegaly
3 Cs, 3 Is
Carcinoma
CCF
CLD
Infection (hepatitis)
Immune (hepatitis)
Infiltrative (sarcoidosis)
Causes of hepatosplenomegaly
CCF
Viral hepatitis
Portal hypertension
What are the causes of portal HTN?
Cardiovascular causes:
Portal vein thrombosis
Budd Chiari (hepatic vein thrombosis)
Right heart failure
Hepatic:
Cirrhosis
Causes of splenomegaly
CHINA
Congestive: portal hypertension, CCF
Haem: sickle cell, haemolytic anaemia
Infection: Malaria, leishmaniasis, EBV
Neoplasm: myelofibrosis, leukaemia and lymphomas
Autoimmune: Felty’s, sarcoidosis, amyloid
How might CML present? What chromosome is associated? How is it treated?
FLAWS
Massive splenomegaly
Bruising/bleeding
Hyperviscosity
Philadelphia chromosome t(9:22)
Tx: Imatinib (tyrosine kinase inhibitor)
What vaccinations are required after splenectomy? Any other precautions?
Pneumococcal
Meningococcal
Hib
Daily Pen V
Carry an alert card
Causes of enlarged kidneys?
Bilateral ADPKD Bilateral RCC Bilateral cysts Hydronephrosis
Unilateral:
Renal RCC
Hydronephrosis
Simple renal cysts
Complications of chronic renal failure?
CRF HEALS
CVD Renal osteodystrophy Fluid overload HTN Electrolyte disturbance Anaemia Leg restlesness Sensory neuropathy
What are the indications for renal replacement therapy?
Sx affecting QOL
Fluid overload
GFR 5-7 ml/min without symptoms
GFR 15ml/min with symptoms
Tx resistant:
HyperK
Acidosis
Complications of dialysis?
CRAMI
CVD Renal cysts Amyloidosis Malnutrition Infection
criteria used to diagnose an acute severe exacerbation of IBD? o
True-Love and Witts Criteria
Takes into account symptoms, systemic signs, lab values.
Management of UC?
5PC - 5AI
Induction:
- 5 ASAs
- Prednisolone
- Ciclosporin/ infliximab
Maintenance:
- 5 ASAs
- Azathioprine
- Infliximab
Management of Crohns?
CAMI
Corticosteroids (e.g. budesonide, prednisolone)
Azathioprine
Methotrexate
Infliximab
AXR findings in UC or Crohn’s?
UC - toxic megacolon
Crohns: strictures and bowel obstruction
Difference in inflammation between UC and CD?
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
Extra intestinal features of IBD
A PIE SAC
Apthous ulcers Pyoderma gangrenosum (UC) Iritis Erythema nodosum Sacroileitus Arthritis Clubbing
Von hippel Lindau
Autosomal dominant, predisposes to cysts neoplasia in multiple organs, such as;
“PH BAKE”
Pancreas Hepatic Brain Adrenals Kidneys Eyes
Types of renal cell carcinoma and classic presentation?
Clear cell
Triad:
Haematuria
Loin pain
Loin mass
Immunosuppressive drugs used after renal transplant? Side effects?
Ciclosporin: calcineurin inhibitor
- Nephrotoxic
- Gum hypertrophy
Tacrolimus: calcineurin inhibitor
- Neurotoxic
Commonest indications for renal transplant?
Diabetic nephropathy Glomerulonephritis PKD Hypertensive nephropathy NOT CANCER
Types of rejection with renal transplant
Hyperacute (minutes)
Acute (<6mo)
Chronic (>6mo)
Indications for dialysis in AKI and generally
generally, when GFR <15ml/min +symptoms , or <7ml/min without symptoms
in AKI:
AEIOU
Acidosis Electrolyte Intoxication Overload Uraemia
Features of CKD?
BIG BEAN
Breathlessness Itching Gout Bone pain Energy levels low Anaemia Neuropathy
Mechanism of peritoneal dialysis
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
Complications of dialysis
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
Types of fistula and location
Brachio-cephalic @ elbow
Radio-cephalic @ wrist
Fistula advantages and disadvantages
Pros:
- High flow rates
- Low infection rates
- Less chance of stenosis
Cons:
- Takes 6 weeks to arterialise
- Body image, psychosocial
- Cannot take blood/BP
PBC; what is it and what antibodies? Tx?
- 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
PSC: what is it and what antibodies?
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
Types of fatty liver disease?
Types:
- NAFLD (obesity)
- Alcoholic fatty liver (leading to alcoholic liver disease
- Acute fatty liver (pregnancy, drugs)
What is NAFLD? What is mainstay of treatment?
4 Stages of NAFLD
- Slightly fatty, no Sx
- NASH
- Fibrosis
- Cirrhosis
Tx: weight loss and CV risk factors
