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Front 1

With antibody-associated glomerular injury the site of the immune complex deposition or formation will largely determines the glomerular response. What happens if the complexes form within the Subendothelial layer?

Back 1

these complexes activate complement, and thus induce an acute inflammatory response

Front 2

With antibody-associated glomerular injury the site of the immune complex deposition or formation will largely determines the glomerular response. What happens if the complexes form within the Mesangial layer?

Back 2

these complexes are likely to induce a mesangioproliferative response

Front 3

With antibody-associated glomerular injury the site of the immune complex deposition or formation will largely determines the glomerular response. What happens if the complexes form within the Subepithelial layer?

Back 3

these complexes are likely to induce production of basement membrane material

Front 4

What is the common cause of minimal change disease and focal segmental glomerulosclerosis?

Back 4

cytokines released from distant lymphocytes or macrophages which localize to the glomerular capillary wall and mediate proteinuria

Front 5

What is the common cause of glomerular injury in Post-infectious strep GI, Serum Sickness GI and Hep C GI?

Back 5

All three of these syndromes are antibody-associated glomerular injuries caused by the Trapping of soluble circulating Ag-Ab complexes in the glomerulus.

Front 6

What type of effacement is seen in by EM in minimal change glomerulonephritis?

Back 6

“lifting off” of the foot processes from the basement membrane

Front 7

The location of glomerular injury can determine the clinicopathological presentation. Describe the location of injury, and the response to the injury that leads to Acute Renal Failure?

Back 7

acute renal failure results from injury is the Endothelial Cells and the response to injury is vasoconstriction

Front 8

The location of glomerular injury can determine the clinicopathological presentation. Describe the location of injury, and the response to the injury that leads to Focal or Diffuse proliferative glomerulonephritis?

Back 8

Focal or Diffuse proliferative glomerulonephritis can be a result of endothelial damage, due to immune complex deposition which results in altered leukocyte adhesion and inflammatory infiltrate within the glomerulus.

Front 9

What glomerular disease results from endothelial damage and the subsequent leukocyte infiltration?

Back 9

?

Front 10

What glomerular disease results from endothelial damage and subsequent vasoconstriction?

Back 10

Acute Renal Failure

Front 11

What glomerular disease results from Mesangial cell injury and the resultant proliferation and increase in BM?

Back 11

Messangioproliferative GN/glomerulosclerosis

Front 12

The location of glomerular injury can determine the clinicopathological presentation. Describe the location of injury, and the response to the injury that leads to Messangioproliferative GN/glomerulosclerosis?

Back 12

Messangioproliferative GN/glomerulosclerosis is caused by Mesangial cell injury and the resultant proliferation and increase in BM

Front 13

The location of glomerular injury can determine the clinicopathological presentation. Describe the location of injury, and the response to the injury that leads to Membranous nephropathy?

Back 13

membranous nephropathy is caused by injury to the basement membrane which results in proteinuria

Front 14

What glomerular disease results from basement membrane injury and the resultant protienuria?

Back 14

Membranous nephropathy

Front 15

What glomerular disease results from parietal cell injury and the resultant crescent formation?

Back 15

Crescentic Glomerularnephritis

Front 16

The location of glomerular injury can determine the clinicopathological presentation. Describe the location of injury, and the response to the injury that leads to Crescentic Glomerulonephritis?

Back 16

Injury to the parietal cells that maintain the bowmans space. This injury results in crescent formation

Front 17

Describe the main difference between nephrotic and nephritic syndromes (both glomerulonephritis syndromes)?

Back 17

Nephrotic syndrome comes on slowly, over months, whereas nephritic syndrome occurs suddenly over days.

Front 18

Describe the first noticed sign of nephrotic syndrome?

Back 18

Usually the first sign of nephrotic syndrome is the slow accumulation of non-dependent oedema (often noticed as facial swelling), caused by hypoalbuminaemia causing osmotic loss of fluid from the blood into the tissues.

Front 19

What is azotemia?

Back 19

reduced GFR

Front 20

Which of the following 7 glomerulonephritis syndromes have a more nephrotic vs nephritis presentation… Minimal change disease, Crescentic GN, Membranous GN, IgA Nephropathy, Membranoproliferative GN, Focal Segmental GN and acute post- infectious GN?

Back 20

Minimal change and membranous GN are predominantly nephrotic (slow in onset, characterised by progressive proteinuria).
The GN associated with cell proliferation and an inflammatory infiltrate are more nephritic, where the inflammation punches holes through the filtration apparatus, resulting in loss of RBCs and acute hematuria.&%&%&%tabel w4

Front 21

What GN syndrome matches this clinical history and why…
Male of 12 years presenting with Acute onset of periorbital swelling, headache, weakness, breathlessness, scanty smoky brown urine and a History of a sore throat 10 days before

Back 21

ACUTE POST-INFECTIOUS GLOMERULONEPHRITIS
1. 12 years – commonest age of onset children 6-10 years

Front 22

What is the main age group that present with acute post-infections glomerulonephritisis?

Back 22

Children 6-10 years old

Front 23

Describe the physical presentation of a patient suffering with acute post-infectious GN?

Back 23

The patient with acute post infectious GN will present with a nephritic pattern of symptoms including…
Pallor, raised JVP, Hypertension, mild facial oedema, fine basal crepitations and smokey brown urine (containing blood and urine)

Front 24

Describe the patholigcal findings of light microscopy, Immunoflorescence and Electron microscopy in acute post infectious glomerulonephritis?

Back 24

LM -Uniformly increased cellularity of the glomerular tufts affecting all glomeruli.
IF – Granular IgG an C3 on capillary loops and mesangium
EM – large subepithelial “humps” of IgG and C3&%&%&%&Acute GN

Front 25

True or False? No organs are in the periotoneal cavity?

Back 25

TRUE – there is only fluid in the peritoneal cavity

Front 26

Which organs lie outside the peritoneal cavity? Intraperitoneal , Extraperitoneal or Retroperitoneal organs?

Back 26

ALL – there are no organs in the peritoneal cavity – only fluid.

Front 27

How many openings does the peritoneal cavity have in males and females?

Back 27

2 openings in female (The peritoneal cavity is open at 2 locations in the female at the abdominal ostia of the 
uterine tubes)
0 openings in males - The peritoneal cavity is closed in the male.

Front 28

Why are females more prone to peritoneal cavity infections cf. males?

Back 28

because in the female the peritoneal cavity is open at 2 locations in the female at the abdominal ostia of the 
uterine tubes, whereas the male peritoneal cavity is closed.

Front 29

Which paracolic gutter is more likely involved in the spread of infectious material in the peritoneal cavity?

Back 29

The right paracolic gutter is most commonly involved because of the occurrence of ruptured appendix, perforated gall bladder and perforated duodenal ulcers on the right side.
It has also been found that when water-soluble contrast material is injected into the pelvic part of the peritoneal cavity, the fluid ascends along the right paracolic gutter into Morrison’s pouch and then into the right subphrenic space. This occurs whether in the supine or erect position. (possibly due to hydrostatic pressure)

Front 30

How do you distinguish between the left and right kidney?

Back 30

the renal vein is the most anterior vessel in the hila &%&%&%HILA w4

Front 31

Describe the order of vessels in the kidney hilum?

Back 31

&%&%&%&HILA W4

Front 32

Describe how you orientate a pancreas?

Back 32

splenic artery superior to body of the pancreas, splenic vein posterior to body of the pancreas&%&%&%&PANCREAS w4

Front 33

What vessels lie anterior to the uncinate process of the pancreas?

Back 33

PANCREAS vein un W4 &%&%&%&%

Front 34

Name the branches of the aorta after it passes through the diaphragm?

Back 34

left and right Phrenic arteries, Coeliac Trunk, left and right Middle Suprarenal arteries and SMA, left and right renal arteries, left and right Gonadal arteries then IMA before the spilt&%&%&%&AA W4

Front 35

What are the branches of the coeliac trunk?

Back 35

Left gastric artery, common hepatic artery and splenic artery &%&%&%& AA W4

Front 36

From where do the proper hepatic artery, right gastric artery, gastroduodenal artery and cystic artery branch from?

Back 36

The middle branch of the coeliac trunk – the common hepatic artery &#&#&#&W4

Front 37

What are the tributaries of the IVC in order?

Back 37

Illiacs, Lumbar, Right Gonadal, left and right renal vien, right suprarenal artery, hepatic veins and phrenic veins&%&%&%&IVC W4

Front 38

What is mesenteric adenitis (lymphadenitis)?

Back 38

an inflammation of the lymph nodes in the mesentry which usually results from an intestinal infection

Front 39

What is a volvulus and which structures are most susceptible to a volvulus and why ?

Back 39

Intestinal volvulus is defined as a complete twisting of a loop of intestine around its mesenteric attachment site.
The most common sites of volvulus are the sigmoid colon and cecum, because they are excessively mobile.

Front 40

What is the phrenicocolic ligament?

Back 40

The phrenicocolic ligaments fixes the left splenic flexure to the diaphragm

Front 41

What does secondarily retroperitoneal mean and what organs are considered secondarily retroperitoneal?

Back 41

"secondarily retroperitoneal", means that the structure developed intraperitoneally but lost its mesentery and thus became retroperitoneal.
Organs which are considered secondarily retroperitoneal….
the head, neck, and body of the pancreas (but not the tail, which is located in the splenorenal ligament)
the duodenum, except for the proximal first segment, which is intraperitoneal
ascending and descending portions of the colon (but not the transverse colon or the cecum) &%&%&%&SECONDARLY W4

Front 42

Describe the orientation of the duodenum?

Back 42

the duodenum commences to the right, and ends to the left, of the midline, and the opening of the “C” is oriented up and to the left.
the four parts of the duodenum, superior, descending, inferior and ascending lie at L1, L2, L3, L2 respectively.&%&%&%DUODENUM w4

Front 43

Where is the duodenojejunal junction?

Back 43

at L2 level a thumb-breadth to left of midline

Front 44

How do you distinguish between the greater omentum and transverse mesocolon?

Back 44

The greater omentum attaches to the anterior surface of the transverse colon and transverse mesencolon posterior surface &%&%&%&Transverse W4

Front 45

Define the transpyloric plane and what is located there?

Back 45

Transpyloric plane is located a L1 - midway between suprasternal notch and pubic symphysis.
The following are located in the transpyloric plane….
Tip of costal cartilage 9
Fundus of gallbladder
Pyloris of stomach (in supine position & empty)
Neck of pancreas in front of beginning of portal vein
Superior mesenteric artery - origin from aorta
R colic flexure slightly below, L colic flexure slightly above
Cysterna chyli
Hila of the kidneys (R slightly below, L slightly above)
End of spinal cord (L1/2 disc)&%&%&%&%&TP w4

Front 46

Name the 6 ligaments on the anterior abdominal wall and what is contained in each?

Back 46

one median umbilical fold on the median umbilical ligament (which in turn, contains the urachus)
two medial umbilical folds on the occluded umbilical artery
two lateral umbilical folds on the inferior epigastric vessels
Falciform ligament which is the remnant of the umbilical vein &%&%&%& UMBILICAL W4

Front 47

Describe how the kidneys lie in situ?

Back 47

the superior poles are closer (~5cm apart) than the inferior poles (~15cm apart), the anterior surfaces face anterolaterally, hila are approximately at transpyloric plane with the left slightly higher, right slightly lower. Kidneys lie at ~T12-L3 vertebral levels when recumbent, and lower when in the upright position.

Front 48

Describe the anterior and posterior relationships of the stomach?

Back 48

Anterior : liver, diaphragm, anterior abdominal wall
Posterior (stomach bed): diaphragm, L suprarenal gland & kidney, pancreas, splenic a., transverse colon & mesocolon

Front 49

Describe the 4 relationships of the gallbladder?

Back 49

The Gallbladder is related to: 1. liver 2. duodenum 3. transverse colon & 4. anterior abdominal wall&%&%&%&gall w4

Front 50

What two compartments make up the greater sac?

Back 50

Supracolic and infracolic compartments&%&%&%&PERI W4

Front 51

Describe the location of the lesser sac versus the greater sac?

Back 51

The lesser sac is located behind the liver and stomach and communicates with the greater sac through the epiploic formen, which then extends up to under the liver infront of the stomach and infront of the coils of the intestines.&%&%&%&PERI w4

Front 52

Describe the natural history and treatment of Acute post infections GN?

Back 52

Most children recover completely (acute signs resolve ~ week, urinary abnormalities may persist for months to years)
Treatment is generally supportive and symptom directed – Note steroid and cytotoxic NOT indicated

Front 53

Describe the histological presentation of diffuse membranous GN?

Back 53

DIFFUSE &%&%&%&

Front 54

Which GN syndrome shows “spikes” in the BM on silver stain?

Back 54

Diffuse membranous GN%&%&%&%& SIVLER w4

Front 55

Describe the aetiology of diffuse membranous glomerulonephritis?

Back 55

85% idiopathic and 15% secondary to either infection, cancer, drugs or autoimmune disease

Front 56

What GN disease can be secondary to SLE?

Back 56

Diffuse membranous glomerulonephritis

Front 57

Describe the clinical course of diffuse membranous glomerulonephritis?

Back 57

Diffuse membranous GN has a notoriously variable course, with 40% of patients progessing to renal failure over 2-20 years, and 20% going into remission
Treatment to steroids is variable too