Abdomen Flashcards
What is the marker of pancreatic cancer
Ca19 -9
How classify ascites?
- High gradient serum: ascites albumin (>11g/L) (hepatic + cardiac causes)
- low gradient serum: ascites albumin (<11g/L) (peritoneal causes)
Name 4 causes high saag ascites
Liver+cardiac causes
HOLM
- heart disease: heart failure, constrictive pericarditis
- obstruction of hepatic veins: Budd chiari syndrome
- Liver disease: cirrhosis, hepatitis, fatty liver, portal vein thrombosis
- malignancy: massive liver metastasis
Name 3 causes low saag ascites
Peritoneal causes
HIM
- hypoalbuminaemia: nephrotic syndrome, protein-losing enteropathy, malnutrition; hypothyroid
- inflammation: pancreatic disease, Tb, infective peritonitis
- malignancy: ovarian, pancreatic cancer, peritoneal metastasis
Name 3 causes hypoalbuminaemia
- nephrotic syndrome,
- protein-losing enteropathy,
- malnutrition
Define budd- chiari syndrome
Occlusion of hepatic vein
Name 3 causes budd- chiari syndrome
Hypercoagulable states.
- Pregnancy + postpartum + oral contraceptives
- polycythaemia Vera
- cancer
Name the clinical triad of budd- chiari syndrome
- Abdominal pain
- ascites
- hepatomegaly
Also: jaundice, spleen enlargement
(Occlusion of hepatic veins)
Name 6 differentials for abdominal distension
6 Fs
- fat
- faeces
- flatus
- foetus
- fluid
- fatal growth
Treatment ascites? (3)
- Spironolactone 100 - 300 mg oral. For rapid results add Lasix (furosemide) 40mg.
- paracentesis if diuretics don’t provide relief.
- surgical tipss (transjugular intrahepatic portosystemic shunt) for refractory ascites
Gold standard to diagnose ascites?
Ultrasound
How calculate SAAG
Serum - ascites albumin gradient = serum albumin - ascites albumin
Nb complication of ascites
Spontaneous bacterial peritonitis
(Neutrophils on ascitic fluid > 0,25 X 10^9/L)
How assess splenomegaly (3)
- Palpate from umbilicus upwards ( enlarge down + medial toward umbilicus)
- percuss Traube’s space: percuss across from medial to lateral. Should remain resonant unless enlarged. Borders = 6th rib MCL medically to 9th rib mal
- percuss over Castell spot: lowest left intercostal space in anterior axillary line. Pt deep breaths. Dull during inspiration if enlarged
Can’t get above it, moves with inspiration towards RIQ, may feel palpable notch on medial side
How Assess hepatomegaly if ascites
Scratch test
Approach to splenomegaly? (7)
MIMIC OH
- = massive splenomegaly
Malignancy
- leukemia * (myeloproliferative)
- Lymphoma (lymphoproliferative)
Infective
- bacterial: endocarditis, sepsis, tb, brucellosis, salmonella
- viral: hepatitis, ebV, CMV
- protozoan: malaria *, leishmaniasis *, trypanosomiasis
- fungal: histoplasmosis
Metabolic (lysosomal storage diseases)
- Gaucher’s disease
- Niemann pick disease
Inflammatory/granulomatous disorders
- Felty’s syndrome in rheumatoid arthritis
- Sarcoidosis
- SLE
Congestive
- portal ht: cirrhosis, hepatic vein occlusion, portal vein thrombosis, stenosis/malformation of portal/splenic vein
- cardiac: chronic CHF, constrictive pericarditis
Other
- cysts, haemophagocytic syndromes
- amyloid
- Thyrotoxicosis
Haematological
- Red cell disorders: megaloblastic anaemia, hb-opathies, hereditary spherocytosis
- autoimmune haemolytic anaemias
- myeloproliferative disorders : myelofibrosis *, polycythaemia rubra Vera, essential thrombocythaemia, chronic myeloid leukemia *
Signs of cholecystitis?
Murphy’s sign
Take in and hold deep breath while palpate r subcostal area. Pain on inspiration = positive
What is Courvoisier’s law
Gallbladder enlarged + jaundice = probably carcinoma of pancreas / lower biliary tree resulting in obstructive jaundice. Unlikely gallstones.
Causes hepatosplenomegaly? (7)
ITCH ABC
- infiltration: amyloid, sarcoid
- thyrotoxicosis
- chronic liver disease with portal hypertension
- Haem: myeloproliferative disease, leukemia, lymphoma, pernicious anaemia, sickle cell anaemia
- acromegaly
- bugs: acute viral hepatitis, infectious mononucleosis, CMV
- Connective tissue disease: SLE
Define ascites
Abnormal accumulation of fluid in peritoneal cavity
What is a negative clinical predictor of ascites
Bipedal oedema
What will ascitic fluid show in cirrhosis (3)
- Clear fluid
- high saag
- transudative: total protein < 2,5 g/ dl
What will ascitic fluid show in spontaneous bacterial peritonitis (2)
- Cloudy
- neutrophils > 250 / mm3
- low total protein < 1,1 g/ dL
What will ascitic fluid show in heart failure (2)
- High saag
- exudative - total protein > 2,5 G / dl
