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MRCP PACES > Station 1: Abdominal > Flashcards

Station 1: Abdominal Flashcards

1
Q

Causes of liver cirrhosis and pulmonary disease

A

Cystic fibrosis

Alpha 1 antitrypsin deficiency

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2
Q

Causes of clubbing

A

ABDOMINAL: liver cirrhosis, primary biliary cirrhosis, inflammatory bowel disease
RESP: CF, bronchiectasis, lung cancer, fibrosis, abscess, empyema
CARDIO: infective endocarditis, congenital heart disease (cyanotic), atrial myxoma
OTHER: idiopathic, thyroid acropachy

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3
Q

Clinical features of primary biliary cirrhosis

A

Symptoms:

  • fatigue
  • pruritis
  • jaundice

usually in middle aged women with other autoimmune conditions e.g. vitiligo, coeliacs, sjogren’s, RA, thyroid disease

Bloods:
anti-mitochondrial antibodies
IgM
raised ALP, bilirubin

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4
Q

Management of primary biliary corrhosis

A

Ursodeoxycholic acid
Cholestyramine as a bile acid sequestrant
Avoid other hepatotoxic agents
Liver transplantation - but 30% recurrence risk

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5
Q

Examination findings in haemochromatois

A

Slate grey discolouration of skin
Bronze skin
Signs of arthropathy and pseudogout
Gynaecomastia
Decreased body hair
Abdominal bruising consistent with insulin injections
Peripheral stigmata of chronic liver disease

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6
Q

Treatment of haemochromatosis

A

Venesection
Iron chelating agents, either as regular infusions or oral agents
Genetic counselling and testing

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7
Q

Causes of splenomegaly

A 
MILD (tip <4cm)
myeloproliferative disorders
lymphoproliferative disorders
portal hypertension
infections e.g. EBV, endocarditis, hepatitis
haemolytic anaemia
Felty's syndrome

MODERATE (tip 4-8cm)
myeloproliferative disorders
lymphoproliferative disorders

MASSIVE (tip >8cm)
BIG 3
1) CML
2) myelofibrosis
3) malaria
OTHERS
myeloproliferative disorders
lymphoproliferative disorders
tropical diseases e.g. leishmanaiasis
infiltrative disorders e.g. amyloidosis
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8
Q

Investigation of splenomegaly

A

Dependent on cause

general:
full blood count
blood film
ultrasound abdomen

specific:
thick and thin films for malaria
viral serology
bone marrow aspirate
lymph node biopsy
imaging e.g. CT NCAP
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9
Q

Indications for splenectomy

A
  1. Rupture

2. Haematological cause e.g. ITP or spherocytosis

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10
Q

Preparation for splenectomy

A

Vaccination against encapsulated bacteria - pneumococcus, meningococcus, haemophilus

Lifelong penicillin

Medicalert bracelet

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11
Q

Causes of BILATERAL renal enlargement

A 
Polycystic kidney disease
Bilateral renal cell carcinomas
Bilateral hydronephrosis
Tuberous sclerosis (cysts + AMLs)
Amyloidosis
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12
Q

Causes of UNILATERAL renal enlargement

A

Polycystic kidney disease (other kidney removed - scar!)
Renal cell carcinoma
Renal cyst
Hydronephrosis

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13
Q

Tell me about polycystic kidney disease

A 
Autosomal dominant
Multiple renal cysts, destruction of normal renal parencyma
Progressive renal impairment and accounts for ~5% of cases of ESRF in UK usually by the age of 40-60 years
Chromosomes 16 (ADPKD1) and 4 (ADPKD2)

Presentation with hypertension, haematuria, abdominal pain or distension, recurrent UTIs

Associated with hepatic cysts, intracranial berry aneurysms (leading to SAH), mitral valve prolapse

Treatment:

  • manage risk factors, blood pressure etc
  • nephrectomy for recurrent infections/bleeding cysts/size
  • RRT if required
  • genetic counselling
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14
Q

Causes of abdominal distension

A 
Fat
Fluid
Foetus
Flatus
Faeces

Other: renal enlargement, uterine/ovarian masses, urinary retention

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15
Q

Causes of hepatomegaly

A
  1. Generalised liver inflammation/hepatitis/infiltration
    - infections e.g. hep A/B/C/E
    - lymphoproliferative disease
    - PBC, haemachromatosis, sarcoidosis, amyloidosis
    - Budd Chiari
  2. Liver lesion (focal)
    - metastasis
    - HCC
    - hydatid cyst
    - amoebic abscess
  3. CCF

Other: Reidel’s lobe (anatomical variant large right lobe

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16
Q

Causes of hepatosplenomegaly

A

Infective e.g. EBV, CMV, tropical infections - Bricellosis, toxoplasmosis, HIV with PGL

Infiltrative e.g. amyloid, sarcoid, lymphoproliferative conditions - CLL, CML, lymphoma, myeloproliferative diseases

Portal hypertension

Haemolytic conditions e.g. hereditary spherocytosis, sickle cell, thalassaemia

17
Q

Tell me about polycythaemia

A

Categorised into primary and secondary

Secondary most common:

  • response to chronic hypoxia e.g. smokers, COPD, OSA, cyanotic heart disease
  • EPO production e.g. renal tumours, APCKD
  • dehydration, diuretics
  • cobalt poisoning

Primary due to increased bone marrow activity

  • JAK2 positive
  • secondary causes excluded
  • microcytic, iron deficient
Clincal features
facial plethora
pruritis worse after a hot shower or bath
engorged conjunctival veins
dilated retinal veins
splenomegaly
hypertension

Complications

  • arterial or venous thromboses (in Budd Chiari - think about PV)
  • peptic ulceration
  • leukaemic transformation

Management

  • control risk factors
  • low dose aspirin
  • hydroxycarbamide
  • venesection
  • chemotherapy options if not controlled
  • treat pruritis: avoid hot showers/baths, antihistamines, SSRIs
18
Q

Complications of renal transplant

A
  • uraemia - failed transplant (fistula use marks)
  • ciclosporin treatment - gum hypertrophy, hypertrichosis (excessive hair)
  • infections from immunosuppression
  • renal tenderness
  • renal bruit (renal artery stenosis)
19
Q

How to examine to see if a renal graft is functioning

A
  1. Examination
    - features of uraemia - pericardial/pleural rub, encephalopathic, grey appearance
  2. Bloods
    - worsening renal function
  3. Bedside tests
    - urine protein, diopstick
  4. Urine volume in 24 hours
  5. +/- biopsy (referral to specialists
20
Q

Complications of renal transplant

A
  1. HYPERACUTE
    - graft rejection
  2. ACUTE
    - graft rejection
    - opportunistic infections
  3. CHRONIC
    - graft rejection
    - opportunistic infections
    - drug side effects e.g. gum hypertrophy, skin malignancies, lymphomas
    - hypertension, ischaemic heart disease
    - renal artery stenosis
    - disease recurrence
21
Q

Causes of gum hypertrophy

A
  • calcineurin inhibitors e.g. tac, ciclo
  • phenytoin
  • leukaemia
  • scurvy
  • nifedipine
22
Q

Mechanism of action of ciclosporin

A

Calcineurin inhibition

Decreased IL2 production

23
Q

Drugs used for immunosuppression post renal transplant

A
  1. Ciclosporin
    - calcineurin inhibitor
    - nephrotoxic
    - hyperlipidaemia, hyperglycaemia, hypertension
  2. Tacrolimus
    - calcineurin inhibitor
  3. Azathioprine
    - bone marrow suppression
    - hepatotoxicity
    - test for TPMT activity
  4. Steroids

MRCP PACES (7 decks)

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