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BPT Shorts > Abdo > Flashcards

Abdo Flashcards

1
Q

DDx Massive hepatomegaly

A
  • Mets
  • alcoholic liver disease with fatty infltrate
  • myeloproliferative disease
  • RHF
  • HCC
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2
Q

DDx Moderate hepatomegaly

A
  • Mets
  • alcoholic liver disease with fatty infltrate
  • myeloproliferative disease
  • RHF
  • HCC

Plus

  • Haemachromatosis
  • CML, Lymphoma
  • Fatty liver - obesity, diabetes, toxins
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3
Q

DDx mild hepatomegaly

A
  • Mets
  • alcoholic liver disease with fatty infltrate
  • myeloproliferative disease
  • RHF
  • HCC

Plus

  • Haemachromatosis
  • CML, Lymphoma
  • Fatty liver - obesity, diabetes, toxins

Plus

  • Hepatitis
  • Cirrhosis
  • Biliary obstruction
  • Granulomatous disorders
  • Hydatid disease
  • Amyloidosis and other infiltrative diseases
  • HIV
  • Ischemia
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4
Q

DDx firm and irregular liver

A

Cirrhosis
Mets
Hydatid disease, granuloma, amyloid, cysts, lipoidoses

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5
Q

DDx tender liver

A

hepatitis
Rapid liver enlargement - RHF, Budd-Chiari syndrome
HCC

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6
Q

DDx Pulsatile liver

A

TR
HCC
Vascular abnormalities

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7
Q

DDx Bilateral renal masses

A 
PCKD
Hydronephrosis or pyonephrosis
Hypernephroma (bilateral RCC)
Acute renal vein thrombosis (bilateral)
Amyloid, lymphoma, other infiltrative disease
Acromegaly
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8
Q

DDx unilateral renal mass

A 
RCC
Hydronephrosis or pyonephrosis
PCKD
Acute renal vein thrombosis
Normal right kidney or a solitary kidney
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9
Q

RIF masses

A 
Appendicieal abscess
Carcinoma of caecum
Crohns disease
Pelvic kidney
Ovarian tumor or cyst
Carcioid tumor
Amoebiasis
Psoas abscess
Ileocecal TB
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10
Q

LIF masses

A 
Faeces
Carcinoma of sigmoid or descending colon
Diverticular disease
Ovarian tumor or cyst
Psoas Abscess
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11
Q

Upper abdo mass

A

Carcinoma of stomach
Carcinoma of transverse colon
Pancreatic pseudocyst or tumor
AAA

Retroperitoneal lymphadenopathy
Pyloric stenosis

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12
Q

DDx massive splenomegaly

A

CML
myelofibrosis
primary lymphoma of spleen, hairy cell leukemia, malaria, kala-azar

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13
Q

DDX Moderate splenomegaly

A

CML
myelofibrosis
primary lymphoma of spleen, hairy cell leukemia, malaria, kala-azar

Plus

  • portal HTN
  • Lymphoma
  • Leukemia
  • Thalassemia
  • Storage diseases (Gaucher’s)
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14
Q

DDx mild splenomegaly

A

CML
myelofibrosis
primary lymphoma of spleen, hairy cell leukemia, malaria, kala-azar

Plus

  • portal HTN
  • Lymphoma
  • Leukemia
  • Thalassemia
  • Storage diseases (Gaucher’s)

Plus

  • myeloproliferative diseases - PRV, ET
  • Haemolytic aneamia
  • megaloblastic anaemia
  • Infection: Viral (mono, hepatitis), bacterial (IE)
  • CTD - RA, SLE, PAN
  • Infiltration - Amyloid, sarcoid
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15
Q

Causes of hepatosplenomegaly

A
  • CLD with Portal HTN
  • Haematological disease - myeloproliferative disease, lymphoma, leukemia, pernicious anaemia, sickle cell anaemia
  • Infection: CMV, EBV, HIV
  • Infiltration - Amyloidosis, sarcoid
  • CTD - SLE
  • Acromegaly
  • Thyrotoxicosis
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16
Q

Distinguishing a spleen from a kidney

A
  • Spleen has no palpable upper border
  • Spleen has a notch
  • Spleen moves inferolaterally on respiration
  • No resonance over splenic mass
  • Spleen is not bimanually palpable (not ballotable)
  • Friction rub may occasional be heard over a spleen
17
Q

Causes of Generalised Lymphadenopathy

A
  1. Lymphoma (rubbery and firm)
  2. Leukemia (CLL, ALL particularly)
  3. Malignant disease
  4. Infections (Viral, bacterial, protozoal)
  5. CTD - RA and SLE
  6. Infiltrative - Sarcoid
  7. Drugs - Phenytoin (pseudolymphoma)
18
Q

What is the definition of mild hepatomegaly?

A

12cm - 15cm

19
Q

What is the definition of moderate hepatomegaly?

A

15cm - 20cm

20
Q

What is the definition of massive hepatomegaly?

A

> 20cm

21
Q

What bedside tests would you do to complete a Gastrointestinal exam?

A
  • Complete examination: inguinoscrotal (LAD, masses, testicular atrophy), rectal exam (bleeding, masses), cardio-respiratory (fluid status) + additional modules as relevant (e.g. alcohol, malignancy)
  • Vital signs: temperature (fevers/infection), oxygen saturation
  • Urinalysis: bilirubin (liver disease), glucose (diabetes/haemachromatosis)
22
Q

Causes of ascites with SAAG >11

A

Indicates portal HTN which is a transudative process

Causes:

  • Cirrhosis
  • Hepatic failure
  • Budd chiari
  • Portal vein thrombus
  • Cardiac failure
  • Constrictive pericarditis
23
Q

Causes of ascites with SAAG < 11

A
  • Malignancy
  • Infection
  • Pancreatitis
  • Nephrotic syndrome
  • Bowel obstruction
  • Bile leak
24
Q

Myelofibrosis: FBE and film

A

Anaemia
Variable WCC and platelet counts

Film:
Teardrops
leukoerythroblastic profile
Circulating nucleated red blood cells

25
Q

CML: FBE and film

A

Raised WCC - neutrophil predominance, eosinophils and basophils also increased
Thrombocytopenia

Film:
Leukoerythroblastic profile
Left shift of neutrophils
Circulating immature cells

26
Q

Polycythaemia rubra vera: FBE and film

A

Increased erythrocytes with raised haematocrit (can also get increase WCC and platelets)

Film:
Erythrocytosis without blast forms

27
Q

Causes of secondary polycythaemia

A

Develops in response to chronic hypoxaemia

OSA
OHS
COPD
Heavy smoking

Testosterone replacement therapy

Erythropoietin-secreting tumours - HCC, RCC, adrenal adenoma

28
Q

ET: FBE and film

A

Increased platelets

Film:
Giant platelets and megakaryocyte fragments

29
Q

Tests for haemolysis

A

Full blood count - Anaemia

Blood film - Schistocytes, spherocytes, keratocytes or other poikilocytosis

Liver function tests - unconjugated hyperbilirubinaemia

Haptoglobin - reduced, particularly in intravascular haemolysis

LDH - Elevated

Reticulocytes - Elevated

Direct antiglobulin test (DAT) - positive in immune haemolysis.

30
Q

FBE findings in splenomegaly

A

Splenic sequestration:
Anaemia
Neutropenia
Thrombocytopenia

If high platelets when spleen is big think myeloproliferative disorder

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