Abdomen

Question 1

CLD

Answer 1

Hepatic flap
Clubbing
Leukonychia
Palma erythema
Dupretren’s Contracture
Jaundice
Fetor Herpaticus
Spider Naevi
Gynaecomastia
Loss of axillary hair
Distended abdominal veins
Hepatomegally (small in cirrhosis)
Ascities

Question 2

Signs of Aetiology of CLD

Answer 2

Sarcoid - Afro-Caribbean

Haemachromatosis - Slate grey pigmentation, arthropathy of the 2nd and 3rd MCP joints, finger pricks from DM

Hepatits C - tattoos, track marks, vasculitic rash

Primary Billiary Cirrhosis - xanthelasma

Autoimmune - Goitre, middle age female

Alpha-1 antriprypsin deficiency - Emphysaema

Question 3

Transplanted kidney

Answer 3

AV fistula
Rutherford - Morrioson Scar (usually RIF)
Smooth mass underlying the scar

Aetiology

DM - Finger pricks
Alport syndrome - Hearling aid
Granulomatosis with polyangiitis - Collapsed nasal bridge
SLE - Malar rash
Renovascular disease - sternotomy scar
PCKD - flank masses

Functionality
flap, excoriations, puncture sites of the AVF, conjunctival pallor, fluid retention

Previous renal replacement therapy
- AVF, central line, tenkoff scars

Complications of immunosuppression
- tremmor, cushingoid, skin lesions, diabetes, hair loss/hursuitism, gingival thickening

Question 4

Polycystic kideny

Answer 4

AVF

HTN
Pale conjunciva

Flank scar - if nephrectomy

Bilateral ballottable flank masses

Hepatomegally

Question 5

Liver transplant

Answer 5

Signs of CLD (but most resolve)

Mercedes benz modification scar

Signs of immunosupression - tremmor, DM, cushings

Question 6

Differentials of massive splenomegally

Answer 6

CML

Lymphoma - 1’ splenic

Myelofibribrosis

Malaria

Hereditary spherocytosis (+jaundice)

Question 7

Differentials for Mild-Moderate splenomegally

Answer 7

Portal HTN

Thalasaemias

Acute or Chronic Lekaemias

Lymphomas

Myeloproliferative - ET, Polycythemia ruba vera

Infections - EBV, bacterial

Autoimmune - SLE, RA (feltys), PAN

Infiltrative - Amyloid, sarcoid

Question 8

Causes of hepato-splenomegally

Answer 8

CLD with portal HTN

Haematological - Myeloprolif, lymphoma, leukaemia

Infiltrative - sarcoid, amyloid

Immune - SLE, RA

Acromegally

Infective - EBV

Question 9

Differentials for hepatomegally

Answer 9

Malignancy - 1’ or 2’

RHF

Alchoholic or non-alcoholic fatty liver disease

Infiltrative - Haemochromatosis, sarcoid, amyloid

Myeloproliferative, Lymphoma, leukaemia

Viral hepatits, autoimmune hepatits, hydatid

Biliary obstruction, PBC, PSC