Causes of end stage renal disease
Polycystic kidney disease
Diabetes mellitus
Hypertension
Glomerulonephritis
Autoimmune condition
Alport disease
Barrier to kidney transplantation
Severe obesity
Active or recent malignancy
Ongoing deep seated infection
Active vasculitis
Long term effect of immunosuppresion
Opportunistic infection
Malignancy, skin malignancy
Steroids : thinning of skin, easy bruising, Cushingnoid apperancmd
Cyclosporine : gingival hyperplasia and renal impairment
Tacrolimus : tremor, new onset diabetes, nephrotoxicity
Crohn’s Disease
Transmural disease
Non casseating granuloma
Fistula and fissuring
Non - bloody diarrhea
Weight loss
Abdominal pain
Peri anal disease - ulcer, skin tag
Extra - intestinal manifestation
Complications : small bowel cancer, colorectal ca, osteoporosis
Extra intestinal manifestation of crohn’s disease
A - Arthritis
C - Clubbing
E - Episcleritis, erythema nodosum,
P - Pyoderma gangrenosum, primary sclerosing cholangitis
O - Osteoporosis, oral ulcer
Investigation of crohn’s disease
Fbc
Raised Crp
Raised Esr
Low B12 and vitamin d
Faecal calprotectin
X Ray : rose thorn apperance
Colonoscopy : cobblestone appearance, deep ulcer, skip lesion, fistula
Bilateral ballotable kidney
Adpkd
Bilateral rcc
Bilateral obstructive uropathy
Vhl
Tsc
Amyloidosis
Infilrative disease
Unilateral ballotable kidney
Pyelonephritis
Hydronephrosis
Rcc
Peri renal hematoma
Renal hyperplasia post nephrectomy
Adpkd with Unilateral enlargement
Why is this a ballotable kidney?
Ballotable and move with respiratory
Can get above swelling
Percussion on it is resonance
Causes of abdominal pain in transplanted kidney
Graft rejection
Graft thrombosis
Graft infection
Renal stone
Ureteric obstruction
Gastritis / pud from steroids
Causes of graft tenderness
Graft infection
Graft rejection
Graft thrombosis
Fever in transplanted kidney
Opportunistic infection
Malignancy
Uti/pyelonephritis
Fistula infection
Anemia + jaundice + hepatosplemomegaly
Myeloproliferative disease
Lymphproliferative disease
Chronic hemolytic anemia
Infection : hiv, disseminated tb, infective mononeuclosis
Typical features of hemolytic anemia
Anemia
Jaundice
Splenomegaly
Confirm of hemolytic anemia
Hb electrophoresis
High reticuloytes count
Fbc with pbf
High serum billirubin
Skeletal survey
Serum iron : high ferritin, high iron, low tibc
Young tender hepatomegaly
Viral hepatitis
Liver abcess
Alcoholic hepatitis
Budd chiarri syndrome
Isolated splenomegaly
Myeloproliferative disease
Lymphproliferative disease
Infection (hiv, malaria)
Hemolytic anemia
Why is this an enlarged spleen?
Move toward right illiac fossa
Cannot get about the spleen (below costal margin)
Not ballotable
Dull on percussion
Presence of splenic notch
Post splenectomy precautions
Vaccination 2/52 prior splenectomy (hemophillus, pneumococcal, meningococcal)
Medical bracelet
Lifelong peniclin
Complications of thalassemia
Extramedullary hemopoiesis
- hepatosplemomegaly, frontal bossing, maxillary prominence
Heart failure
- anemia causing high output heart failure
- restrictive cardiomyopathy secondary to iron overload
Iron overload
- hemochromatosis - > chronic liver disease + stigmata of cld + bronze skin appearance
- bronze DM : finger prick mark, dermopathy, insulin site
- pseudogout
- hypogonadotrophic hypogonadism: loss of axillary hair, short stature, testicular atrophy, amenorrhea
Chronic hemolysis
- cholelithiasis/ cholecystectomy
- splenomegaly/ splenectomy
- transfusion dependent
Indication of splenectomy
Hypersplenism - massive spleen/ rupture/ pain
High transfusion requirement - > 250ml/kg/ year or doubling of volume per year
Splenic infact/ splenic vein thrombosis
Investigation for thalassemia
Fbc (to look for anemia)
Fbp (to look for target cell)
Rp / lft
Hemolytic workup
Hb electrophoresis
Complications
- pituitary hormone screening
- metabolic : fbs / Hba1c
- hemochromatosis : mri t2* (heart/ liver)
- hepatitis (regular transfusion)
- dexa scam
- us abdomen
-
Investigation for thalassemia
Fbc - look for anemia
Fbp - look for target cell
Hb electrophoresis and dna analysis - to confirm diagnosis
Rp and lft
Complications
- metabolic : fbc/Hba1c
- pituitary panel
- iron overload (mri t2* - heart and liver)
- hepatitis panel
- echo
- osteoporosis : dexa scan
Management of thalassemia
MDT
Patient education and counselling
Dietitian - low iron / high protein diet
Annual vaccination
Pharmacology
Regular transfusion (aim hb >10)
Iron chelating - evidence of overload
Bone protective agents
Monitor bp / sugar/ cholesterol
Surgical
Splenectomy
Cholecystectomy
Hsct
