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23 Cards in this Set
- Front
- Back
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Causes of hepatomegaly |
Common causes are 3 Cs Cirrhosis, carcinoma & CCF
Other causes are 3 I's Infiltrative = amyloid, myeloproliferative, Wilson's, HH Infection = HBV, HCV Immune = PBC, PSC, autoimmune hep |
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Causes of ascites |
Ascites can be transudative or exudative Calculate with SAAG = serum albumin - ascitic albumin. >11mmol/L difference = transudative <11mmol/L difference = exudative
Exudative = malignancy, pancreatitis, TB peritonitis Transudative = CCF, liver failure, nephrotic syndrome, Budd-Chiari syndrome (hepatic vein thrombosis/obstruction) |
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Features of a liver |
Felt in RUQ Moves on inspiration Cannot get above it Can be hard and craggy = malignancy/cirrhosis |
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Signs of decompensated liver disease |
3 A's Asterixis Abnormal GCS (encephalopathy) Ascites |
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Complications of cirrhosis |
Varices Encephalopathy SBP |
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Ix to do in hepatomegaly |
Bloods = FBC, U+Es, LFTs, albumin, clotting Imaging = USS Other = ascitic tap, Echo
Liver screen Hepatitis serology AFP (HCC) Autoantibodies = AMA (PBC), Anti-smooth muscle (autoimmune hep), immunoglobulins (PSC) Caeruloplasmin Ferritin Alpha-1 antitrypsin May do liver biopsy for ?HCC and ERCP for ?PSC |
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Management of ascites |
Alcohol abstinence Salt restriction Diuretics Therapeutic drains Liver transplant |
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DDx for palmar erythema |
Cirrhosis Thyrotoxicosis RA Pregnancy Polycythaemia |
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DDx of gynaecomastia |
Drugs = spirinolactone, digoxin Liver cirrhosis Klinefelter's syndrome Testicular tumours or orchidectomy Hyper/hypothyroidism or Addison's disease Physiological = old age, puberty
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Causes of splenomegaly |
Classify according to size
Massive (>8cm) = myelofibrosis, CML, Gauchers, malaria, visceral leishmaniasis (protazoal infection which is second biggest parasite killer to malaria worldwide) Moderate (4-8cm) = myeloproliferative disorders Tip (<4cm) = myeloproliferative disorders, infection (EBV, IE), congestive (portal HTN) and haemolytic anaemia
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Features of a spleen on examination |
Mass in LUQ Moves infero-laterally on palpation Has a notch Cannot get above it or ballot it |
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Indications for a splenectomy |
Trauma Haematological = ITP or hereditary spherocytosis |
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Work up for a splenectomy |
Vaccinate (ideally 2/52 before) - Pneumococcal - Haemophillus influenza (HiB) - Meningococcal Prophylactic penV Medic alert bracelet |
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Kidney examination |
Peripheral Signs of immunosuppresion (Cushingoid, gum hypertrophy after ciclosporin) Fistula (thrill? bruit?) or tunnelled line HTN
Abdomen Nephrectomy scar Rutherford-Morrison scar + renal transplant Ballotable kidney
(Hepatomegaly, peritoneal dialysis scars, indwelling catheter) Mention examining external genitalia (varicocele) and dipsticking urine (microscopic haematuria/proteinuria) |
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Causes of unilateral enlarged kidney |
Autosomal dominant polycystic kidney disease Renal cell Ca Simple cysts Hydronephrosis |
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Causes of bilaterally enlarged kidneys |
Autosomal dominant polycystic kidney disease Bilateral hydronephrosis Bilateral renal cell Ca Amyloid Tuberous sclerosis (renal angiomyolipomata & cysts) |
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Tuberous sclerosis features |
Adenoma sebaceum = facial angiofibromas Shagreen patches = area of red-orange plaque on sacrum Ungual fibromas Renal angiomyolipomata Ash leaf macules = areas of depigmented skin
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Investigations in renal pts. |
Bloods = FBC, U+Es Urine = dipstick Imaging = USS +/- biopsy, CT KUB Genetic studies if ?ADPKD |
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ADPKD - Frequency - Genetics - Clin features - Extra-renal involvement - Dx - Mx |
1:1000 affected Autosomal dominant pattern of inheritance Most common congenital cause of renal failure. 5% of all end stage renal failure in UK Clin features = haematuria, recurrent UTIs, abdo pain w/ cyst rupture & HTN Extra-renal involvement = berry aneurysms (SAH), liver cysts and mitral valve prolapse Dx = <30yrs needs 2 cysts in 1 kidney, 30-59yrs needs 2 cysts in 2 kidneys and 60yrs+ needs 4 cysts in both kidneys Mx involves supportive care, dialysis, nephrectomy and trasnplant Reasons for nephrectomy = size, recurrent infections, HTN and bleeds |
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Signs in transplant pt. - Scars - Liver pt. - Renal pt. - Transplant associated signs |
Scars = Rutherford-Morrison (kidney) or rooftop/Merc-Benz (liver) Liver pt. = indications to cause (IVDU/tattoos, pigmented = HH, other autoimmune disease = PBC, evidence of chronic LD) Renal pt. = nephrectomy scar, ADPKD, fistulae, peritoneal dialysis scars, tunnelled line/scar, signs of DM or autoimmune
Transplant assoc signs Signs of steroid or ciclosporin use (gum hypertrophy) Skin cancer = actinic keratoses, SCC (100x increased risk) or BCC/melanoma (10x increased risk) Infection = warts & cellulitis |
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Top 3 indications for renal transplant |
Glomerulonephritis Diabetic nephropathy ADPKD |
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Top 3 indications for liver transplant |
Cirrhosis Fulminant liver failure (Hep A, B & paracetamol OD) HCC |
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Problems post-transplant |
Rejection (acute/chronic) Infection (CMV, PCP) Pathology assoc = skin Ca, CV disease, lymphoprolif disorders Recurrence of original disease Toxicity of immunosuppression Psychological |
