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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
Q

What can cause mild splenomegaly?

A

Polycythaemia
Haemolytic anaemias
Infection
Infiltration
Connnective tissue diseases

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26
Q

What are the haematological causes of hepatosplenomegaly?

A

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

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27
Q

What are the most common causes of cirrhosis in the UK?

A

Alcohol
Viral
NAFLD
Autoimmune (PBC, PSC, AIH)
Genetic (WIlson’s, HH)
Drugs (Isoniazid, Methotrexate, Amiodarone)
Vascular (Budd-Chiari)
Idiopathic

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28
Q

What are the complications of cirrhosis?

A

Liver Failure
Ascites
Portal Hypertension
Jaundice
HCC

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29
Q

How do you manage Cirrhosis?

A

Slow disease (Antiretrovirals, immunosuppression)

Prevent damage (Stop drinking, vaccinate against Hep B/C)

Screen for complications (USS and AFP, 6 monthly)

ABx
Liver transplant

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30
Q

Why do people get oedema in liver disease?

A

Low albumin due to poor synthetic function

Stimulated RAAS = fluid retention

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31
Q

What are the signs of a patient having undergone renal replacement therapy?

A

AV Fistula
Scars from catheter sites

32
Q

Which drugs are used in suppressing the immune response following renal transplant?

A

Ciclosporin
Steroids

33
Q

Which clues might indicate the aetiology behind the disease leading to a patient’s need for a renal transplant?

A

Unilateral/bilateral palpable kidneys (PKD)

34
Q

What are the indications for renal transplant?

A

All with end stage renal failure (GFR <15)
Those with stage 4 CKD and progressive disease

35
Q

What are the key contraindications for renal transplant?

A

Untreated malignancy
Untreated HIV
Any condition with life expectancy of <2 years
malignant melanoma

36
Q

What might cause the need for a kidney transplant?

A

HTN
DM
Glomerulonephritis
PKD

37
Q

Which symptoms might indicate a failing graft?

A

Tenderness, fever, fluid retention, abdo pain, oliguria

38
Q

Which investigations must be carried out prior to renal transplant?

A

Renal screen
Routine Bloods
Viral Serologies
G&S Cross Match
ECG
Echo
PFTs
CXR (immunosuppressants can reactivate TB)

39
Q

How are patients with kidney grafts routinely managed?

A

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
Q

Incision and indication?

A

Kocher Incision

Biliary Surgery
Hepatic Surgery (needs wider incision if transplant)

41
Q
A

Upper Midline Laparotomy

Nissen’s Fundoplication
Upper GI Surgery
Realistically any major abdo surgery, especially emergency repairs of AAA, hartmann’s procedure etc

42
Q

Number 3, couldnt find a real pic sorry

A

Transverse Upper Abdominal Incision

Repair of congenital diaphragmatic hernia
Splenic Surgery

43
Q
A

Ramstedt’s Pyloromyotomy

Pyloric Stenosis mx

44
Q
A

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
Q
A

Umbilical Scar

Hernia repair
Gastrochisis Repair
Exomphalos

46
Q
A

Laparoscopic port scars

Drian Sites

47
Q
A

Inguinal hernia in man with midline laparotomy scar

48
Q
A

Markings for hockey stick incision (likely renal transplant)

Scars indicating previous laparoscopy

49
Q
A

Pfannenstiel Scar

C-Section
Gynae surgery

50
Q
A

Rooftop scar

Hepatobiliary Surgery (Liver transplant, whipple’s procedure, liver resection)

Gastric Surgery

51
Q
A

Nephrectomy

RCC
PKD

52
Q

What are the main complications of abdominal surgery?

A

Immediate - Anaesthetics (oropharyngeal trauma, malignant hyperthermia), Surgical trauma to local structures (AVN), Haemorrhage

Early - VTE, atelectasis, urinary retention

Late - Scarring, Neuropathy, Graft failure

53
Q
A

Infected midline laparotomy

54
Q

Which operations form an ileostomy?

A

End Ileostomy - Panproctocolectomy (Permanent), Total Colectomy - UC, FAP

Loop Ilesotomy - Anterior resection for colon cancer/Crohn’s

55
Q

Which operations form a colostomy?

A

End Colostomy - AP resection, Hartmann’s (Diverticulitis, Colon Cancer)

Loop Colostomy - Inoperable bowel cancer which is obstructing

56
Q

How do you present a stoma?

A

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
Q

What are the complications of stomas?

A

Immediate - anaesthetic risks, haemorrhage, perforation

Early - Ischaemia, high output, retraction

Late - Hernia, prolapse, dermatitis

58
Q

How would you carry out an abdominal exam?

A

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
Q

How would you present a normal abdominal exam?

A

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
Q

Extra parts to offer at end of abdo exam

A

For completeness, I would like to take a comprehensive history and perform examinations of the Cardiovascular and respiratory systems.

61
Q

Which investigations are commonly offered in Abdo stations?

A

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
Q
A

Mercedes Benz Scar

Liver Transplant
Whipple’s Procedure

63
Q

What is Whipple’s Procedure?

A

Pancreaticoduodenectomy

64
Q

How would you examine an inguinal hernia?

A

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
Q

What might cause hepatomegaly?

A

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
Q

What might cause Hyposplenism?

A

Coeliac
IBD
Splenectomy

67
Q

Operation?

A

Splenectomy?

68
Q

What can cause enlarged kidneys?

A

Bilateral - PKD, Hydronephrosis, Amyloidosis, normal if slim

Unilateral - RCC, Cyst, Hydronephrosis

69
Q

Investigate ?PKD?

A

Urine dip

FBC/U&Es/Bone Profile

Abdo USS for cysts

Echo for MV prolapse

CT/MRI for berry aneurysms

70
Q

What can cause CKD?

A

DM
HTN
Renal artery stenosis
Glomerulonephritis
SLE
Amyloidosis

71
Q

What are the main complications of dialysis?

A

CVD
Malnutrition
Infection

72
Q

What can cause Ascites?

A

3Cs

Cirrhosis
CCF
Carcinomatosis

73
Q

How would you manage ascites?

A

Fluid restrict
Low Na
Spironolactone
Therapeutic Paracentesis

74
Q

How would you manage chronic liver disease?

A

Conservative - Dietician, toxin cessation, vaccines

Medical - Chloestyramine for pruritus, laxatives, ABX if risk of SBP

Surgical - TIPS, Liver transplant

75
Q

Typical IBD presentation?

A

Hands - Clubbing, Leukonychia

Eyes - Pale, episcleritis

Abdo - Laparotomy scars, stoma, tender on palpation

76
Q

Signs to look out for in Chronic liver disease?

A

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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