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2PACES COPY y6 > Medical Abdomen > Flashcards

Medical Abdomen Flashcards

1
Q

Causes of splenomegaly

A 
Infections 
Haemolysis 
Portal hypertension
Malignancy
Felty's syndrome
Infective endocarditis
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2
Q

Signs of decompensated liver disease

A 
 Jaundice
 Encephalopathy: asterixis, confusion
 Foetor hepaticus: ammonia and ketones 
 Hypoalbuminaemia: oedema and ascites 
 Coagulopathy: bruising
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3
Q

Causes of CLD

A

Common
 EtOH
 Viral
 NASH

Rare
 Genetic: HH
 AI: AH
 Drugs: methotrexate

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4
Q

Drug for pruritus

A

Cholestyramine

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5
Q

Mx of Hepatitis C

A

interferon-α + ribavarin

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6
Q

Mx of encephalopathy

A

Nurse in well lit, calm environment
Correct any precipitants
Avoid sedatives
Give Lactulose + rifaximin

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7
Q

How to treat hepatorenal syndrome?

A

IV albumin + terlipressin

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8
Q

Mx ascites?

A

Conservative: fluid and salt restrict, daily weight
Medical: Spironolactone/ Furosemide
Surgical: Ascitic Tap, TIPS

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9
Q

Complications of chronic liver disease

A
  1. Liver failure/decompensation
  2. SBP
  3. Portal HTN: SAVE
  4. HCC
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10
Q

How is Cirrhosis graded?

A

Child Pugh Score

Graded A-C using severity of 5 factors (ABCDE)

 Albumin
 Bilirubin
 Clotting
 Distension: ascites 
 Encephalopathy
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11
Q

Precipitants of Encephalopathy

A

DIGS

Diuretics
Infection
GI bleed
Sepsis/ stroke

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12
Q

How would you manage decompensated liver disease?

A 
General Mx
 HDU or ITU
 Rx any precipitant
 Good nutrition: e.g. via NGT with high carbs
 Thiamine supplements
 Prophylactic PPIs vs. stress ulcers

Monitoring
 Fluids: urinary and central venous catheters
 Bloods: daily FBC, U+E, LFT, INR
 Glucose: 1-4hrly + 10% dextrose IV 1L/12h

Mx Complications
 Ascites: daily wt, fluid and Na restrict, diuretics, tap
 Coagulopathy: Vit K, FFP, platelets
 Encephalopathy: avoid sedatives, lactulose, rifaximin
 Sepsis / SBP: tazocin or cefotaxime
 Hypoglycaemia: dextrose
 Hepatorenal syndrome: IV albumin + terlipressin

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13
Q

Pathophysiology of encephalopathy

A

 ↓ hepatic metabolic function
 Diversion of toxins from liver directly into systemic
system.
 Ammonia accumulates and passes to brain where
astrocytes clear it causing glutamate → glutamine
 ↑ glutamine → osmotic imbalance → cerebral oedema.

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14
Q

Presentation of encephalopathy

A 
 Asterixis, Ataxia
 Confusion
 Constructional apraxia 
 Dysarthria
 Seizures
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15
Q

What is Hepatorenal syndrome?

A

Cirrhosis → splanchnic arterial vasodilatation → effective circulatory volume → RAS activation → renal arterial vasoconstriction.

Persistent underfilling of renal circulation → failure

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16
Q

What makes up the portal triad?

A

Hepatic artery
Portal vein
Bile duct

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17
Q

Mx of SBP

A

Tazocin or cefotaxime until sensitivities known

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18
Q

Causes of ascites

A 
 Cirrhosis
 CCF
 Carcinomatosis
 Budd Chiari
 TB
 Pancreatitis
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19
Q

SAAG interpretation

A

Serum Ascites Albumin Gradient
SAAG = Se albumin – Ascites Albumin

SAAG ≥1.1g/dL = Portal HTN (97% accuracy)
 Cirrhosis in 80%

SAAG <1.1g/dL
 Neoplasia: e.g. peritoneal mets or ovarian Ca
 Inflammation: pancreatitis
 Nephrotic syndrome
 Infection: TB peritonitis
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20
Q

Causes of portal HT

A 
Pre-hepatic:
 Portal vein thrombosis 
 PV, ET
 PNH
 Nephrotic syndrome

Hepatic:
 Cirrhosis

Post-hepatic
 Cardiac: RHF, TR, constrictive pericarditis
 Budd-Chiari (hepatic vein thrombosis)

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21
Q

Symptoms of SBP

A

Fever, abdo pain and ascites

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22
Q

Management of refractory ascites

A

TIPSS

Transplant

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23
Q

Causes of Jaundice

A

Pre-hepatic (haemolysis - unconjugated)

  • AIHA
  • HS
  • SCD

Hepatic (conjugated/ unconjugated)

  • CLD
  • Hepatitis
  • Drugs

Post Hepatic (conjugated)

  • Gallstones
  • Ca Head Panc
  • LN enlargement
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24
Q

Mercedes Benz scar ddx

A

 Liver transplant
 Segmental resection
 Whipples’: pancreaticoduodenectomy

25
Q

Causes of Hepatomegaly

A 
Malignancy
Cirrhosis (ALD, NASH, PBC)
Congestion
Infections (Viral, Toxo, Abscess)
Infiltration (amyloid, sarcoid)
Vasc (Budd-chiari, Sickle Cell)
26
Q

Imaging you would consider for hepatomegaly

A

Abdo US
PV + Hepatic duplex
CT
MRI (enhanced with gadolinium)

27
Q

How do you treat HH?

A

Venesection + desferrioxamine

28
Q

How do you treat Wilson’s?

A

Penicillamine

29
Q

How can you tell you are palpating the spleen?

A 
 Can’t get above it
 Moves inferiorly toward RIF on respiration 
 Notch
 Dull PN
 Not ballotable
30
Q

Function of the spleen

A 
 Phagocytosis of old RBCs, WBCs
 Phagocytosis of opsonised bugs: esp. encapsulates
 Antibody production
 Sequestration of formed blood elements
 Platelets, lymphocytes and monocytes
 Haematopoiesis
31
Q

Causes of hyposplenism

A

 Splenectomy
 Coeliac disease
 IBD
 SCD

32
Q

Indications of a splenectomy

A 
 Trauma - uncontrollable splenic bleeding, hilar vascular injuries, devascularised spleen
 Rupture: e.g. secondary to EBV
 AIHA
 ITP
 HS
 Hypersplenism
33
Q

Complications of splenectomy

A

 Redistributive thrombocytosis → early VTE
 Temporary post-op aspirin prophylaxis

 Gastric dilatation: transient ileus
 May disturb gastro-omental vessel ligatures
 Prophylactic NGT post-op

 Left lower lobe atelectasis

 Pancreatitis: tail shares blood supply ̄c spleen

 ↑ susceptibility to infections
 Encapsulates: haemophilus, pneumo, meningo

34
Q

Causes of enlarged kidneys

A 
Bilateral
 ADPKD
  Diabetes
  HIV
 Bilateral RCC (5%)
 Bilateral cysts: e.g. in VHL
 Amyloidosis
Unilateral
 Simple renal cyst
 RCC
 Compensatory hypertrophy
 + contralateral nephrectomy: ADPKD
35
Q

Mx of ADPKD

A

General
 ↑ water intake, ↓ Na, ↓ caffeine (may ↓ cyst formation)

Monitor U+E and BP

Genetic counselling
 50% chance of transmission
 10% are de novo mutations
 MRA screen for berry aneurysms

Medical
 Rx HTN aggressively: <130/80 (ACEi best)
 Rx infections

Surgical: Nephrectomy
 Recurrent bleeds or infections
 Abdominal discomfort

36
Q

Risk factors for RCC

A 
 Smoking
 Obesity
 HTN
 Dialysis: 15% of pts. develop RCC
 4% heritable: e.g. VHL syndrome
37
Q

Presentation of RCC

A

Haematuria
Loin pain
Loin mass
Invasion of L renal vein → varicocele

38
Q

Mx of RCC

A

Medical
 Reserved for pts. ̄c poor prognosis
 Temsirolimus (mTOR inhibitor)

Surgical
 Radical nephrectomy
 Consider partial if small tumour or 1 kidney
 Prognosis: 45% 5ys

39
Q

Differentials for gum hypertrophy

A 
 Drugs: ciclosporin, phenytoin, nifedipine
 Familial
 AML
 Scurvy
 Pregnancy
40
Q

Commonest indications for a renal transplant

A

 Diabetic nephropathy
 GN
 Polycystic Kidney Disease
 Hypertensive nephropathy

41
Q

Contraindications for a renal transplant

A

 Active infection
 Cancer
 Severe co-morbidity
 Failed pre-implantation x-match

42
Q

Symptoms of renal transplant rejection

A

Hyperacute rejection: minutes
 Path: ABO incompatibility
 Presentation: thrombosis and SIRS

Acute Rejection: <6mo
 Path: Cell-mediated response
 Presentation
       Fever and graft pain 
       ↓ urine output
       ↑ Cr
 Rx: Responsive to immunosuppression

Chronic Rejection: >6mo
 Presentation: Gradual ↑ in Cr and proteinuria
 Path: Interstitial fibrosis + tubular atrophy
 Rx: supportive, not responsive to immunosuppression

43
Q

Complications of dialysis

A 
 Cardiovascular disease
 Malnutrition
 Infection
 Amyloidosis
 β2-microglobulin accumulation
 Renal cysts → RCC
44
Q

Complications of AV access

A 
 Bleeding
 Aneurysm
 Thrombosis and stenosis
 Infection
 Steal syndrome
45
Q

General complications of dialysis

A 
 Malnutrition
 Infection
 Cardiovascular disease
 Amyloidosis
 Renal cysts → RCC
46
Q

Complications of haemodialysis

A

Disequilibration syndrome (leads to cerebral oedema)
Fluid balance: BP↓, pulmonary oedema
Electrolyte imbalance
Aluminium toxicity (in dialysate) → dementia
Psychological factors

47
Q

Methods of renal replacement therapy

A

Haemodialysis
Peritoneal dialysis
Renal transplant
Haemofiltration

48
Q

Catheter used with peritoneal dialysis

A

Tenchkhoff catheter

49
Q

Types of AV fistula

A

 Radio-cephalic @ wrist = Cimino-Brescia

 Brachio-cephalic @ the elbow

50
Q

Complications of a tunnelled cuffed catheter

A

Adverse events @ insertion: e.g. pneumothorax Line or tunnel infection
Blockage
Retraction

51
Q

The commonest cause of CKD

A

HT
DM
RAS
GN

52
Q

Complications of CKD

A

CRF HEALS

 Cardiovascular disease
 Renal osteodystrophy
 Fluid (oedema)

 HTN
 Electrolyte disturbances: K, H
 Anaemia
 Leg restlessness
 Sensory neuropathy
53
Q

Signs of IBD

A 
General
 Often young female pt. 
 Laparotomy scars
 Malnutrition or wt. loss
 Cushingoid
 Pallor

Hands
 Clubbing
 Leukonychia
 Beau’s lines

Eyes
 Pale conjunctivae
 Iritis, episcleritis

Mouth
 Aphthous ulcers
 Gingival hypertrophy (cyclosporin)

Legs
 Erythema nodosum
 Pyoderma gangrenosum

54
Q

Acute Severe Exacerbation or IBD Criteria

A

True-Love and Witts Criteria

Symptoms
 BMs>6x/d
 Large PR bleed

Systemic Signs
 ↑HR>90
 Pyrexia >37.8

Laboratory Values
 ↓ Hb <10.5g/dL
 ESR >30mm/Hr

55
Q

Drugs for UC induction

A

Oral

1: 5-ASAs
2: prednisolone
3: ciclosporin / infliximab

Topical: Enemas / foams

  • 5-ASA
  • Pred
56
Q

Drugs for CD induction

A

Oral

1: Ileocaecal: budesonide
1: Colitis: sulfasalazine
2: prednisolone (tapering)
3: methotrexate
4: infliximab / adalimumab

57
Q

Drugs for UC maintenance

A

1: 5-ASA
2: azathioprine
3: infliximab / adalimumab

58
Q

Drugs for Crohn’s maintenance

A

1: azathioprine/mercaptopurine
2: methotrexate
3: infliximab / adalimumab

2PACES COPY y6 (12 decks)

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