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scientific basis of medicine > The Case of the Swollen Belly > Flashcards

The Case of the Swollen Belly Flashcards

1
Q

5 F’s of enlarged abdomen

A 
fluid
flatus (obstruction)
faeces
fat 
foetus
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2
Q

caput medusae

A

swollen abdo wall veins due to portal hypertension

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3
Q

abdominal paracentesis

A

puncture of the abdomen for aspiration of fluid in the peritoneal cavity

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4
Q

how much fluid filtered into large body cavities per day?

A

how much fluid filtered into large body cavities per day?

20L

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5
Q

how much fluid is reabsorbed back into circulation?

A

how much fluid is reabsorbed back into circulation?

90%, rest returns as lymph fluid

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6
Q

why does fluid leave capillaries?

A

high pressure pushes fluid into interstitial space

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7
Q

why does fluid reenter venous circulation?

A

low pressure causes reabsorption

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8
Q

what 4 things affect Qf/filtration/reabsorption rate of fluid?

A

change in hydrostatic pressure
change in oncotic pressure
change in permeability
change in exchange area

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9
Q

Where are serous membranes located?

A

pericardium
pleura
peritoneum
tunica vaginalis of testis

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10
Q

are effusions always pathological?

A

yes, but only clinically detectable once a certain size

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11
Q

transudate

A

plasma filtrate forced into tissues, low protein content

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12
Q

what causes transudate?

A

↑ Hydrostatic pressure
or
↓ Oncotic pressure

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13
Q

what causes exudate?

A

increased vascular permeability, change in exchange area

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14
Q

exudate

A

unfiltered plasma with high protein content

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15
Q

what causes hydrostatic pressure change?

A

portal hypertension

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16
Q

what causes 80% of portal hypertension?

A

liver cirrhosis

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17
Q

Other causes of portal hypertension (aside from liver cirrhosis)

A

alcoholic hepatitis

chronic cardiac failure

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18
Q

what causes oncotic pressure change?

A

hypoalbuminuria (caused by nephrotic syndrome, malnutrition, protein losing enteropathy)

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19
Q

what affects exchange area or vascular permeability?

A

malignancy, infection

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20
Q

Serum Albumin Ascites Gradient (SAAG)

A

a value which suggests portal hypertension if >1.1g/dl, if lower not portal hypertension

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21
Q

diagnostic technique for ascites

A

ascitic aspiration

22
Q

risk of ascitic drainage (5)

A 
bleeding
infection
pain
leakage at drainage site
procedure failure
23
Q

Seldinger technique

A

A technique that involves inserting a needle with a syringe, then inserting a guide wire into the needle, removing the needle, making an incision, and inserting a catheter over the guide wire; the guide wire is then removed

24
Q

what does pale yellow watery fluid aspirated suggest?

A

transudate

Low protein

25
Q

what does brown aspirated fluid suggest?

A

haemorrhage

26
Q

what does turbid and white/yellow aspirated fluid suggest?

A

infection or malignancy

27
Q

what does green aspirated fluid suggest?

A

bile

28
Q

what cells might be present in effusions?

A 
mesothelial cells
macrophages
lymphocytes
neutrophils
eosinophils
plasma cells 
artefacts
29
Q

Ferruginous bodies

A

asbestos fibers coated with iron, usually seen trying to be absorbed by 2 macrophages

30
Q

what do lupus cells look like morphologically?

A

what do lupus cells look like morphologically?

large macrophages with an engulfed nucleus

31
Q

what does lymphocytes all at same stage of maturation in an effusion suggest?

A

lymphoma

32
Q

Features of mesothelioma

A

DIFFUSE nodular pleural thickening (not discrete)
Often unilateral
Thickening of fissures

33
Q

DIFFUSE nodular pleural thickening (not discrete)
Often unilateral
Thickening of fissures
= features of…

A

Features of mesothelioma

34
Q

melanoma markers

A

S-100, HMB-45, melan A, SOX-10

35
Q

small cell carcinoma of the lung markers

A

Napsin A, TTF-1

36
Q

what is seen on doppler US in portal hypertension?

A

reversal of flow in portal vein

37
Q

issues with iodine contrast for CT

A

can cause allergic reactions

contrast induced nephropathy

38
Q

fine needle aspiration (FNA)

A

biopsy technique that uses a narrow hollow needle to obtain tiny amounts of tissue for pathologic examination

39
Q

benefits of FNA

A

outpatient, minimal discomfort
rapid results
excellent cell preservation

40
Q

2 ways of fixing cytology samples

A

air dry

alcohol fixation

41
Q

can you use formalin in cytology

A

no destroys the cells

42
Q

Cytospin

A
  • cytological technique specifically designed to concentrate cells on a slide in a
    uniform monolayer using high speed centrifuge. The monolayer distribution improves the
    morphological appearance of the cell present
43
Q

3 causes of lymph node enlargement

A

reactive lymphadenitis, metastatic malignancy, lymphoma

44
Q

causes of reactive lymphadenopathy (5)

A 
HIV
mononucleosis
SLE
RA
syphilis
45
Q

causes of granulomatous lymphadenitis

A 
TB
cat scratch disease
leprosy
silica
lymphoma
sarcoid
46
Q

breast adenocarcinoma cytology

A

diffuse cell pattern

proliferation spheres

47
Q

stomach adenocarcinoma cytology

A

signet ring cells

dispersed single cells

48
Q

lung adenocarcinoma cytology

A

highly vacuolated
papillary groups
dense cytoplasm

49
Q

Colorectal Adenocarcinoma cytology

A

tall columnar cells

nuclear palisading

50
Q

features of air dried slide samples

A

cytoplasmic features visible

metachromasia

51
Q

features of fixed slide samples

A

features of fixed slide samples
transparent
nuclear detail and keratinisation
hyperchromasia

52
Q

hyperchromasia

A

abundant DNA, extremely dark staining

scientific basis of medicine (35 decks)

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