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Finals Elliot > PACES - Abdo > Flashcards

PACES - Abdo Flashcards

1
Q
A

Hypoalbuminaemia
Chronic liver disease

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2
Q
A

Koilonychia
Iron deficiency

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3
Q
A

Palmar Erythema

Chronic Liver Disease
Pregnancy
Hypertension

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4
Q
A

AV fistula
Indication of dialysis

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5
Q
A

Kayser Fleischer Rings

Wilson’s Disease

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6
Q
A

Angular Cheilitis

Severe IDA

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7
Q
A

Atrophic Glossitis

IDA

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8
Q

What is Troisier’s Sign

A

Node in left supraclavicular fossa (Virchow’s Node)

Gastric Cancer
Breast Cancer
Any other Abdominal Cancer

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9
Q
A

Spider Naevus

Fill from centre, caused by chronic liver disease (if more than 5)

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10
Q
A

Ileostomy
Spouted, typically RIF

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11
Q
A

Colostomy

Flush with skin, typically LIF

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12
Q
A

Caput Medusae

Cirrhosis

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13
Q

What can cause ascites?

A

Cirrhosis
Cancer
Heart Failure
Rarely Tb

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14
Q

How is jaundice classified?

A

Pre-Hepatic (Haemolysis, SCA, Spherocytosis, G6PD def, Malaria, Drug reactions, transfusion reactions)

Hepatic - Conjugated (Viral, Malignancy, Cirrhosis, Drugs) Unconjugated (Gilbert’s, Crigler-Najar)

Post-Hepatic (Gallstones, Biliary tree compression eg pancreatic cancer, PBC, PSC

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15
Q

Which 3 blood tests examine synthetic liver function?

A

Clotting (PT)
Platelets
Albumin

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16
Q

List some extra-intestinal features of crohn’s

A

Enteric Arthritis
Uveitis
Erythema Nodosum
Pyoderma Gangrenosum
Clubbing

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17
Q

How is Crohn’s managed?

A

A-E if acute

Bloods - FBC, CRP, ESR etc

Cultures - Blood and Stool

Small bowel follow through (Barium enema)

CT/MRI

Colonoscopy with Biopsy

Aid with nutritional and occupational support

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18
Q

How is Crohn’s managed?

A

Supportive management = fluids, analgesia, thromboprophylaxis

Steroids, Anti-TNFS, Aminosalicylates

Surgery

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19
Q

What are the main complications of IBD?

A

Toxic Megacolon

Strictures and obstruction

Cancer

Nutritional Deficiencies

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20
Q

What are the most common cause of hepatomegaly in the UK?

A

Alcohol
Cancer (mets then HCC)
Congestive Cardiac Failure

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21
Q

List a few differentials for hepatomegaly

A

Infection 0 Hepatitis, malaria, EBV, CMV, abscess

Cirrhosis, NAFLD,

Tumours

Amyloidosis, Sarcoidosis

Drugs

metabolic - haemochromatosis, wilson’s, porphyrias

Biliary, PBC, PSC, Onstruction

Congestive - CCF

budd- chiari

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22
Q

How would you differentiate between a kidney and splenomegaly on examination?

A

Spleen has a medial notch, kidney doesn’t
You can’t get above the spleen (ribs overly it)
The spleen moves towards RIF with inspiration, the kidney moves posterior only (if at all)
The spleen is not ballotable like the kidney

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23
Q

What can cause massive splenomegaly?

A

Myelofibrosis
CML
Malaria
VIsceral liesmaniasis

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24
Q

What can cause moderate splenomegaly?

A

Other myeloproliferative diseases (note CML and myelofibrosis can cause massive splenomegaly)
Portal hypertension
Thalassaemia
Glycogen storage disorders

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25
What can cause mild splenomegaly?
Polycythaemia Haemolytic anaemias Infection Infiltration Connnective tissue diseases
26
What are the haematological causes of hepatosplenomegaly?
Leukaemias (AML, CML, ALL, CLL) Lymphomas Myelofibrosis Myeloproliferative disease Essential thrombocytopenia, polycythaemia, primary myelofibrosis, CML Haemolytic anaemias Hb disorders: Thalassaemia, sickle cell disease (eventually leads to splenic atrophy) Red cell structure: Spherocytosis/elliptocytosis Enzyme: G6PD deficiency, pyruvate kinase deficiency
27
What are the most common causes of cirrhosis in the UK?
Alcohol Viral NAFLD Autoimmune (PBC, PSC, AIH) Genetic (WIlson's, HH) Drugs (Isoniazid, Methotrexate, Amiodarone) Vascular (Budd-Chiari) Idiopathic
28
What are the complications of cirrhosis?
Liver Failure Ascites Portal Hypertension Jaundice HCC
29
How do you manage Cirrhosis?
Slow disease (Antiretrovirals, immunosuppression) Prevent damage (Stop drinking, vaccinate against Hep B/C) Screen for complications (USS and AFP, 6 monthly) ABx Liver transplant
30
Why do people get oedema in liver disease?
Low albumin due to poor synthetic function Stimulated RAAS = fluid retention
31
What are the signs of a patient having undergone renal replacement therapy?
AV Fistula Scars from catheter sites
32
Which drugs are used in suppressing the immune response following renal transplant?
Ciclosporin Steroids
33
Which clues might indicate the aetiology behind the disease leading to a patient's need for a renal transplant?
Unilateral/bilateral palpable kidneys (PKD)
34
What are the indications for renal transplant?
All with end stage renal failure (GFR <15) Those with stage 4 CKD and progressive disease
35
What are the key contraindications for renal transplant?
Untreated malignancy Untreated HIV Any condition with life expectancy of <2 years malignant melanoma
36
What might cause the need for a kidney transplant?
HTN DM Glomerulonephritis PKD
37
Which symptoms might indicate a failing graft?
Tenderness, fever, fluid retention, abdo pain, oliguria
38
Which investigations must be carried out prior to renal transplant?
Renal screen Routine Bloods Viral Serologies G&S Cross Match ECG Echo PFTs CXR (immunosuppressants can reactivate TB)
39
How are patients with kidney grafts routinely managed?
Reviewed at specialist centre Regular Bloods BP/CVS risk monitored Assessment for graft function, drug side effects (check gums for gum hypertrophy if on ciclosporin) Annual Flu Vaccine Dip urine
40
Incision and indication?
Kocher Incision Biliary Surgery Hepatic Surgery (needs wider incision if transplant)
41
Upper Midline Laparotomy Nissen's Fundoplication Upper GI Surgery Realistically any major abdo surgery, especially emergency repairs of AAA, hartmann's procedure etc
42
Number 3, couldnt find a real pic sorry
Transverse Upper Abdominal Incision Repair of congenital diaphragmatic hernia Splenic Surgery
43
Ramstedt's Pyloromyotomy Pyloric Stenosis mx
44
Gridiron scar at mcburney's point Mcburney's Point = Junction of distal third and proximal two thirds of the line between the umbilicus and the ASIS
45
Umbilical Scar Hernia repair Gastrochisis Repair Exomphalos
46
Laparoscopic port scars Drian Sites
47
Inguinal hernia in man with midline laparotomy scar
48
Markings for hockey stick incision (likely renal transplant) Scars indicating previous laparoscopy
49
Pfannenstiel Scar C-Section Gynae surgery
50
Rooftop scar Hepatobiliary Surgery (Liver transplant, whipple's procedure, liver resection) Gastric Surgery
51
Nephrectomy RCC PKD
52
What are the main complications of abdominal surgery?
Immediate - Anaesthetics (oropharyngeal trauma, malignant hyperthermia), Surgical trauma to local structures (AVN), Haemorrhage Early - VTE, atelectasis, urinary retention Late - Scarring, Neuropathy, Graft failure
53
Infected midline laparotomy
54
Which operations form an ileostomy?
End Ileostomy - Panproctocolectomy (Permanent), Total Colectomy - UC, FAP Loop Ilesotomy - Anterior resection for colon cancer/Crohn's
55
Which operations form a colostomy?
End Colostomy - AP resection, Hartmann's (Diverticulitis, Colon Cancer) Loop Colostomy - Inoperable bowel cancer which is obstructing
56
How do you present a stoma?
Where? Spouted? How many lumens? Bag contents? Signs of complications? Associated scars? I would like to assess more closely for complications, digitate the hernia and assess the perineum. Differentials for hernia
57
What are the complications of stomas?
Immediate - anaesthetic risks, haemorrhage, perforation Early - Ischaemia, high output, retraction Late - Hernia, prolapse, dermatitis
58
How would you carry out an abdominal exam?
Inspect from edge Inspect Hands, Pulse, Clubbing, Asterixis, Look specifically for AV fistula Inspect Face, eyes, mouth Inspect abdomen - look for scars and stoma Palpate soft and deep Offer murphy's sign in patient with suspected biliary pathology Palpate for liver and spleen Palpate AAA Percuss for liver and spleen Percuss for Bladder Percuss for Ascites (Shifting dullness) Listen for bowel sounds Listen for Aortic/Renal Bruits Offer to assess for hernias and genitals Conclude.
59
How would you present a normal abdominal exam?
I performed an abdominal exam on X From the edge of the bed the patient looked well at rest lying at 45 degrees, and there were no paraphernalia of abdominal disease around the bed. On inspection of the hands, CAP refill was normal, pulse was 60 and regular and there were no signs of abdominal pathology, including no AV fistulae. Inspection of the face displayed no signs of abdominal pathology. On inspection of the abdomen, no scars or stomas were noted. No signs of hepatosplenomegaly were noted on palpation and percussion. There was no shifting dullness. No pulsatile mass indicative of a AAA was identified. Bowel sounds were present and normal. To conclude etc.
60
Extra parts to offer at end of abdo exam
For completeness, I would like to take a comprehensive history and perform examinations of the Cardiovascular and respiratory systems.
61
Which investigations are commonly offered in Abdo stations?
Bedside: Urine dipstick Labs: Full liver screen including LFTs, FBC, Clotting and GGT Autoantibody screen including ANA, Anti-mitochondrial, Anti-smooth muscle U&Es, Urine dip Imaging: MRCP, USS, AXR Other: Biopsy, Ascitic tap, MRCP/ERCP,
62
Mercedes Benz Scar Liver Transplant Whipple's Procedure
63
What is Whipple's Procedure?
Pancreaticoduodenectomy
64
How would you examine an inguinal hernia?
Gloves Pt standing, inspect Palpate from Pt's side. Find midpoint of inguinal ligament. Ask pt to cough. Feel for previous mesh Auscultate for bowel sounds. No = likely omentum Ask pt to reduce. Attempt to block deep ring Repeat with patient lying down.
65
What might cause hepatomegaly?
4 Cs 3 Is HVO Cancer, Cirrhosis, Chronic Liver, CCF Infection, Immune, Infiltrative (amyloidosis) Haem: Leukaemia/Lymphoma Vascular (Budd-Chiari) Other: COPD (chest expansion)
66
What might cause Hyposplenism?
Coeliac IBD Splenectomy
67
Operation?
Splenectomy?
68
What can cause enlarged kidneys?
Bilateral - PKD, Hydronephrosis, Amyloidosis, normal if slim Unilateral - RCC, Cyst, Hydronephrosis
69
Investigate ?PKD?
Urine dip FBC/U&Es/Bone Profile Abdo USS for cysts Echo for MV prolapse CT/MRI for berry aneurysms
70
What can cause CKD?
DM HTN Renal artery stenosis Glomerulonephritis SLE Amyloidosis
71
What are the main complications of dialysis?
CVD Malnutrition Infection
72
What can cause Ascites?
3Cs Cirrhosis CCF Carcinomatosis
73
How would you manage ascites?
Fluid restrict Low Na Spironolactone Therapeutic Paracentesis
74
How would you manage chronic liver disease?
Conservative - Dietician, toxin cessation, vaccines Medical - Chloestyramine for pruritus, laxatives, ABX if risk of SBP Surgical - TIPS, Liver transplant
75
Typical IBD presentation?
Hands - Clubbing, Leukonychia Eyes - Pale, episcleritis Abdo - Laparotomy scars, stoma, tender on palpation
76
Signs to look out for in Chronic liver disease?
Hands - Palmar erythema, spider naevi, dupuytren's contracture Signs of decompensation (Asterixis, Bruising, altered consciousness) Hepatomegaly, Ascites, Prominent abdo veins if portal htn

Finals Elliot (12 decks)

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