Abdomen Flashcards
What is a normal liver span?
12cm
What are gastro causes of clubbing?
IBD
Cirrhosis
Coeliacs
What are the signs of chronic liver disease?
Hypoalbuminaemia
- leukonychia
Oestrogen excess
- palmar erythema
- spider naevi
- gynaecomastia
- testicular atrophy
Hepatic decompensation
- jaundice
- flap
- fetor
- confusion
Bruising (coagulopathy)
ETOH
- Dupeytren’s contracture
- parotid enlargement
What are signs of portal hypertension?
Ascites
Splenomegaly
Caput medusa
Petechiae
How to differentiate a kidney from an enlarged spleen?
- spleen moves inferiomedially on inspiration, whereas kidney moves inferiorly
- spleen has notch
- cannot get above the spleen
- kidney is ballotable
- spleen will be dull to percussion
If ascites are present, how can you differentiate the cause?
SAAG = serum ascites to albumin gradient
High (>11) =
- cirrhosis + portal hypertension
- alcoholic hepatitis
- hepatic failure
- Budd-Chiari
Low
- malignancy
- nephrotic syndrome
Differentials for hepatosplenomegaly?
Haematological malignancy / MPNs CLD with portal HTN Viral infection -> EBV / CMV / HIV / Hep Connective tissue disease -> SLE, RA Infiltration -> sarcoid, amyloid Endocrine -> Acromegaly / Thyrotoxicosis
Differentials for moderate splenomegaly?
Causes of massive splenomegaly =
- MPNs -> chronic myeloid leukaemia / myelofibrosis
- malaria or infection
- primary lymphoma of spleen, hairy cell leukaemia
PLUS
- CLD with portal hypertension
- Haematological malignancy -> lymphoma, leukaemia
- Thalassaemia
What are complications that indicate decompensated cirrhosis?
- Variceal hemorrhage
- Ascites
- Spontaneous bacterial peritonitis
- Hepatic encephalopathy
- Hepatocellular carcinoma
- Hepatorenal syndrome
- Hepatopulmonary syndrome
Risk factors / triggers for decompensation?
- bleeding
- infection
- ETOH
- medications (sedatives)
- dehydration
- constipation
DDx of Massive hepatomegaly?
- metastases / HCC
- alcoholic liver disease with fatty infiltration
- myeloproliferative neoplasms
- right heart failure
DDx of Moderate hepatomegaly?
Causes of massive hepatomegaly =
- metastases / HCC
- alcoholic liver disease with fatty infiltration
- myeloproliferative neoplasms
- right heart failure
PLUS
- haemochromatosis
- haematological disease – leukaemia, lymphoma
- fatty liver – obesity
DDx of Mild hepatomegaly?
Causes of massive hepatomegaly =
- metastases / HCC
- alcoholic liver disease with fatty infiltration
- myeloproliferative neoplasms
- right heart failure
AND Causes of moderate hepatomegaly =
- haemochromatosis
- haematological disease – leukaemia, lymphoma
- fatty liver – obesity
PLUS =
- hepatitis (viral, drugs)
- cirrhosis
- biliary obstruction
- granulomatous / infiltrative diseases
Causes of bilateral renal masses?
- Polycystic kidneys
- Hydronephrosis or pyonephrosis (bilateral)
- Hypernephroma (bilateral renal cell carcinoma)
- Acute renal vein thrombosis (bilateral)
- Amyloid, lymphoma and other infiltrative diseases
- Acromegaly
Causes of unilateral renal mass?
- Renal cell carcinoma
- Hydronephrosis or pyonephrosis
- Polycystic kidney (asymmetrical enlargement)
- Acute renal vein thrombosis
What are the possible associated examination findings in PCKD?
- Hypertension
- Anaemia (from CKD) or Polycythaemia (due to high erythropoietin levels)
- Cranial surgery (aneurysms)
- Hepatic cysts
- Splenic cysts
- Urinalysis
- > Haematuria (due to haemorrhage into a cyst)
- > proteinuria (usually less than 2 g / day)
DDx for massive splenomegaly?
- MPNs -> chronic myeloid leukaemia / myelofibrosis
- malaria or infection
- primary lymphoma of spleen, hairy cell leukaemia
What are signs on examination for chronic ETOH overuse?
Dupeytren’s contracture
Parotid enlargement
(Any CLD signs)
Neurological Cx
- peripheral neuropathy
- proximal myopathy
- cerebellar syndrome with ataxia
- Wernicke’s encephalopathy (bilateral VI nerve palsies / nystagmus)
What are classical exam features of haemochromatosis?
- Signs of CLD
- Pigmentation (bronze)
- Arthropathy (typically degenerative arthritis of the MCP joints of the index and middle fingers, but any other joint may be involved; pseudogout may occur)
- testicular atrophy (due to iron deposition in the pituitary gland)
- dilated cardiomyopathy
- glycosuria (as a result of diabetes mellitus)
Causes of tender hepatomegaly?
Hepatitis
HCC
Rapid liver enlargement from Budd-Chiari / RHF
Causes of RIF masses?
Bowel abscess / carcinomas
Ovarian tumour or cyst
Carcinoid tumour
Amoebiasis / TB
Psoas abscess
Causes of mild splenomegaly?
Causes of massive splenomegaly =
- MPNs -> chronic myeloid leukaemia / myelofibrosis
- malaria or infection
- primary lymphoma of spleen, hairy cell leukaemia
AND Causes of moderate splenomegaly =
- CLD with portal hypertension
- Haematological malignancy -> lymphoma, leukaemia
- Thalassaemia
PLUS
- anaemias with extra-medullary haematopoiesis
- infections (EBV, CMV, Hepatitis, IE)
- CTD – RA, SLE
- infiltration – amyloidosis, sarcoidosis
