Abdo (Imperial Jan Revision Course)

Question 1

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Question 3

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Question 16

liver disease; eamination findings

Answer 16

• Chronic liver disease

– Palmar erythema

– Dupuyten’s contracture

– Spider naevi

• Portal hypertension

– Ascites

– Caput medusae

– Enlarged abdominal veins

– Associated splenomegaly

• Liver failure /decompensation

– Asterixis

– Foetor hepaticus

– Bruising

– Gynaecomastia

– Ascites/Oedema

– Low JVP

Question 17

• Why is it a liver?

Answer 17

– RUQ mass, moves with respiration, can’t get above it, can palpate the lower edge at….

Question 18

CLD; Stable chronic liver disease with portal HTN

PRESENT

Answer 18

Present your findings – “Mr Smirnoff is a 78 year old russian gentleman who is sitting comfortably at rest with palmar erythema, dupuytren’s contracture and spider naevi. He has an enlarged liver felt 3 fb below the costal margin, and prominent abdominal veins. However he has no asterixis, bruising or other signs of decompensation. These findings would be consistent with chronic liver disease with associated portal hypertension, but without signs of acute decompensation”

Question 19

Hepatosplenomegaly

PACES; Differentia diagnosis

Answer 19

• Distinguish between liver disease as a cause and other conditions

– Haematologic

– myeloproloferative disease, leukaemia, sickle cell disease, myelofibrosis

– Infection

– malaria, leishmaniasis!

– Other

– amyloidosis, metabolic disorders

• Main differential is liver disease with portal hypertension from haematologic disease in PACES
• Again the key is looking for peripheral signs

Question 20

Isolated Splenomegaly

PACES; differential diagnosis

Answer 20

• This is rare
• Mainly haematologic disease for PACES

– Myelofibrosis

– CML

– CLL

– Lymphoma

– PRV

• Malaria, leishmaniasis, schistosomiasis

Question 21

Big kidneys

PACES Differential diagnosis

Answer 21

Big kidneys

• Bilateral palpable kidneys = Polycystic kidney disease
• Single palpable kidney = very rare
• For these patients check for signs of renal replacement therapy – either CAPD catheter or fistula for haemodialysis (NB is fistula functional?)
• Also check for a renal transplant – often in the iliac fossa

Question 22

Renal transplant

PACES; eamination

Answer 22

• Smooth firm mass – often in the iliac fossa
• Associated with a scar!
• Check for signs of previous renal replacement therapy
• Look for old fistulae (scarred) / scars from CAPD catheter insertion