Pre Session Lists Flashcards
What are the 5 main physical signs of Chronic Liver Disease?
Spider naevi
Clubbing
Dupuytrens contracture
Palmar erythema
Gynaecomastia
Why can you get gynaecomastia with chronic liver disease?
Reduced hepatic clearance of oestrogen
What are some causes of a high MCV on an FBC?
Vitamin B12 deficiency (diet, malabsorption,)
Folate deficiency
Alcohol intake, alcoholic liver disease
Bone marrow disorders like myelodysplasia
Medications (methotrexate)
Hypothyroidism
Reticulocytosis
Pregnancy
What are some common causes of hyperkalaemia?
PSEUDOHYPERKALAEMIA
CKD
AKI
Addisons (would also have low Na+)
Spironolactone
Amiloride
ACEi (Ramipril)
ARBs
Acidosis (DKA)
NSAIDs
Rhabdomyolysis
Insulin deficiency
Periodic paralysis syndrome
What are some common causes of hypokalaemia?
Loop diuretics
Thiazide diuretics
Hyperaldosteronism (Conns or secondary)
Cushings
Salbutamol
Corticosteroids
Vomiting
Diarrhoea
Alkalosis
Periodic paralysis syndrome
What are the 4 categories of causes of clubbing?
Respiratory
Gastrointestinal/hepatic
Cardiovascular
Other
What are the respiratory causes of clubbing?
Lung cancer
TB
Bronchiectasis
Lung abcesses
Idiopathic pulmonary fibrosis
Cystic fibrosis
What are the gastro/hepatic causes of clubbing?
IBD
Liver cirrhosis
Malabsorption (Coeliacs)
What are the cardiovascular causes of clubbing?
Cyanotic congenital heart defects (tetralogy of fallot)
Infective endocarditis
Atrial Myxoma
What are the miscellaneous causes of clubbing?
Familial idiopathic clubbing
Thyroid acropachy (graves)
What is considered postural hypotension?
Systolic BP drop by 20mmHg or more within 3 mins of standing
Diastolic BP drop of 10mmHg or more within 3mins of standing
What are the types of causes of postural hypotension?
Primary causes
Secondary causes
Medications
What are the primary causes of postural hypotension?
Autonomic nervous system dysfunction
Parkinson’s (Dopamine is vasodilator)
MS
What are some patient causes of postural hypotension?
Dehydration/volume depletion:
-vomitting
-diarrhoea
-blood loss
-poor fluid intake
What are some endocrine and cardiac causes of postural hypotension?
Addisons
Diabetes Mellitus
HF
LV dysfunction
Arrhythmias
Aortic stenosis
What is the most common cause of postural hypotension?
PROLONGED BED REST/DECONDITIONING
Why can diabetes Mellitus cause postural hypotension?
Can cause autonomic neuropathy
What are some medications that can cause postural hypotension?
Any anti HTN:
-B blockers
-Diuretics
-ACEi
Vasodilators:
-GTN
-CCBs
Psychoactives (anticholinergic effects):
-antidepressants
-sedatives
Parkinson’s meds:
-dopamine agonists
-monoamine oxidase inhibitor
What are the 4 categories of causes of a low sodium (Hyponatraemia)?
Dilutional hyponatraemia
Sodium loss
Inadequate sodium intake
Other
What are the causes of dilutional hyponatraemia?
SIADH
Heart failure
Renal failure
Hypothyroidism
Primary Polydipsia
Why can hypothyroidism cause dilutional hyponatraemia?
Decreases renal function leading to reduced water clearance
What are the causes of hyponatraemia via sodium loss?
Diuretics (THIAZIDES, furosemide)
Addisons disease
Renal salt wasting (nephrotic syndrome)
What are the causes of inadequate sodium intake of hyponatraemia?
Severe malnutrition
Excessive beer
What are the OTHER causes of hyponatraemia?
Diabetes Insipidus
Post op excessive fluids
What is the general thought process you should go through when assessing a patient with hyponatraemia?
- Are they on a thiazide?
- Are they dehydrated
- Do they have SIADH
- Is the K+ raised? Yes maybe Addisons
- Liver cirrhosis?
- Heart failure
How can you determine if a patient has SIADH?
Low serum osmolality with higher urine osmolality
What is the treatment for SIADH?
Fluid restriction
How can you determine if a patient has addisons?
Low sodium + High potassium
Measure cortisol levels and should be low
