Abdo Flashcards
What are the signs of portal hypertension on examination?
Ascites Bleeding, varices, purpura Caput medusae Diminished liver Enlarged spleen
What are the findings in decompensated chronic liver disease?
Findings associated with decompensated cirrhosis are:
- Oesophageal variceal bleeding
- Hepatic encephalopathy
- Ascites
- SBP
- HCC
- Hepatorenal syndrome
- Hepatopulmonary syndrome
What are the possible aetiologies of chronic liver disease?
Chronic viral hepatitis (B, C)
Alcohol-associated
Haemochromatosis
MAFLD
Less common: Autoimmune Primary and secondary biliary cirrhosis PSC Medications (MTX, isoniaid) Wilson disease Coeliac disease Alpha-1 antitrypsin deficiency Polycystic liver disease Infection (eg brucellosis, syphilis, echinococcosis) R side heart failure Hereditary haemorrhagic telangiectasia Veno-occlusive disease
What features would lead you to diagnose PCKD?
Patients with ADPKD can present with hypertension, hematuria, proteinuria, or kidney function impairment. Flank pain, due to kidney hemorrhage, obstructive calculi, or urinary tract infection, is the most common symptom reported by patients
Flank fullness
Ballotable kidneys
Cerebral aneurysms
How do you differentiate L) renal mass from spleen?
- Spleen moves down and medial, compared with kidney which moves downwards but not medially
- Spleen has a notch on its upper border (spleen needs to be at least moderate for a notch to be appreciated)
- Spleen is not ballotable
- Cannot get above a spleen
- Splenomegaly causes dullness in Traube’s space
What are extra-renal manifestations of PCKD?
Cerebral aneurysms
Poly cystic liver disease
What are side effects of ISx that may be found on examination?
How would you investigate Kidney transplant graft function?
Where is the liver span measured?
Mid-clavicular line
What liver span defines massive hepatomegaly?
Massive hepatomegaly >20 cm
What liver span defines moderate hepatomegaly?
Moderate hepatomegaly: 15 - 20 cm
What are the differential diagnoses for massive hepatomegaly?
Myelofibrosis
Myelodysplasia
Liver metastases, hepatocellular carcinoma
Chronic liver disease with fatty infiltrate
Tricuspid regurgitation (pulsatile liver)
What are the differential diagnoses for moderate hepatomegaly?
As for massive hepatomegaly Haemochromatosis Myelodysplasia CML Lymphoma MAFLD
What are the differential diagnoses in mild hepatomegaly?
Same as for moderate/massive hepatomegaly
What are the differentials for marked splenomegaly?
Myelofibrosis
CML
Myelodysplasia
What are the differentials for moderate splenomegaly?
Lymphoma
CLL
PRV
Portal hypertension (with CLD, liver may be small due to cirrhosis)
What are the differentials for mild splenomegaly?
PRV, ET, haemolytic anaemia, ITP
Connective tissue disorders
Sarcoid, amyloid
Portal hypertension (with signs of CLD)
What are the differential diagnoses for hepatosplenomegaly?
- CLD but ONLY if there is a concurrent infiltrative disorder (Fatty liver, haemochromatosis, hepatitis, hepatoma, amyloid, sarcoid)
- Acute infections
- Infiltrative disorders: Lymphoid, amyloid
- Connective tissue diseases
- Myelofibrosis, myelodysplasia (CML)
- CLL, Lymphoma
What are the differential diagnoses for massive hepatomegaly and splenomegaly?
Myelofibrosis
Myelodysplasia (CML/CMML)
What are the differentials for moderate hepatomegaly and moderate splenomegaly?
Myelofibrosis
Myelodysplasia (CML/CMML)
CLL
Lymphoma
What are the anatomic landmarks of Traube’s space?
Superior: Left 6th rib
Lateral: Left mid axillary line
Inferior: Left costal margin
Normal liver span?
12 cm
mildly enlarged liver span?
12 - 15cm
Moderately enlarged liver span?
15-20
Massively enlarged liver span?
> 20 cm
Massive hepatomegaly - differentials
Myelofibrosis, myelodysplasia
Secondaries or hepatoma
CLD with fatty infiltration or hepatoma - look for evidence of CLD
TR, pulsatile
Moderate hepatomegaly - differentials
As for massive
Haemochromatosis
Myelodysplasia, CML, Lymphoma
Fatty liver, metabolic syndrome, diabetes etc.
Massive splenomegaly - differentials
Myelofibrosis
CML
Myelodysplasia
Moderate splenomegaly - differentials
Lymphoma, CLL, PRV
Portal hypertension
Mild splenomegaly - differentials
PRV, ET, Haemolytic anaemia, ITP, Thalassaemia, Sickle cell Acute leukaemia, epecially AML CTD Sarcoid, amyloid Acromegaly Portal hypertension (with signs of CLD)
Hepato-splenomegaly - differentials
- CLD but ONLY if there is a concurrent infiltrative disorder (Fatty liver, haemochromatosis, hepatitis, hepatoma)
- Acute infections
- Infiltrative disorders: Lymphoid, amyloid
- Connective tissue diseases
- Myelofibrosis, myelodysplasia (CML)
- CLL, Lymphoma
Abdo inspection - 10 things
Patient's age Patient's face (PCV, jaundice, drowsiness) Body (malnourished, cachectic) Flanks Umbilicus Organs, liver, spleen, kidneys Scars (renal transplant, tenkhoff catheters) Veins Masses Tubes
