Abdomen

Question 1

What is a normal liver span?

Answer 1

12cm

Question 2

What are gastro causes of clubbing?

Answer 2

IBD
Cirrhosis
Coeliacs

Question 3

What are the signs of chronic liver disease?

Answer 3

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

Question 4

What are signs of portal hypertension?

Answer 4

Ascites
Splenomegaly
Caput medusa
Petechiae

Question 5

How to differentiate a kidney from an enlarged spleen?

Answer 5

• 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

Question 6

If ascites are present, how can you differentiate the cause?

Answer 6

SAAG = serum ascites to albumin gradient

High (>11) =

• cirrhosis + portal hypertension
• alcoholic hepatitis
• hepatic failure
• Budd-Chiari

Low

• malignancy
• nephrotic syndrome

Question 7

Differentials for hepatosplenomegaly?

Answer 7

Haematological malignancy / MPNs
CLD with portal HTN 
Viral infection -> EBV / CMV / HIV / Hep
Connective tissue disease -> SLE, RA
Infiltration -> sarcoid, amyloid
Endocrine -> Acromegaly / Thyrotoxicosis

Question 8

Differentials for moderate splenomegaly?

Answer 8

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

Question 9

What are complications that indicate decompensated cirrhosis?

Answer 9

• Variceal hemorrhage
• Ascites
• Spontaneous bacterial peritonitis
• Hepatic encephalopathy
• Hepatocellular carcinoma
• Hepatorenal syndrome
• Hepatopulmonary syndrome

Question 10

Risk factors / triggers for decompensation?

Answer 10

• bleeding
• infection
• ETOH
• medications (sedatives)
• dehydration
• constipation

Question 11

DDx of Massive hepatomegaly?

Answer 11

• metastases / HCC
• alcoholic liver disease with fatty infiltration
• myeloproliferative neoplasms
• right heart failure

Question 12

DDx of Moderate hepatomegaly?

Answer 12

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

Question 13

DDx of Mild hepatomegaly?

Answer 13

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

Question 14

Causes of bilateral renal masses?

Answer 14

• Polycystic kidneys
• Hydronephrosis or pyonephrosis (bilateral)
• Hypernephroma (bilateral renal cell carcinoma)
• Acute renal vein thrombosis (bilateral)
• Amyloid, lymphoma and other infiltrative diseases
• Acromegaly

Question 15

Causes of unilateral renal mass?

Answer 15

• Renal cell carcinoma
• Hydronephrosis or pyonephrosis
• Polycystic kidney (asymmetrical enlargement)
• Acute renal vein thrombosis

Question 16

What are the possible associated examination findings in PCKD?

Answer 16

• 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)

Question 17

DDx for massive splenomegaly?

Answer 17

• MPNs -> chronic myeloid leukaemia / myelofibrosis
• malaria or infection
• primary lymphoma of spleen, hairy cell leukaemia

Question 18

What are signs on examination for chronic ETOH overuse?

Answer 18

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)

Question 19

What are classical exam features of haemochromatosis?

Answer 19

• 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)

Question 20

Causes of tender hepatomegaly?

Answer 20

Hepatitis
HCC
Rapid liver enlargement from Budd-Chiari / RHF

Question 21

Causes of RIF masses?

Answer 21

Bowel abscess / carcinomas

Ovarian tumour or cyst

Carcinoid tumour

Amoebiasis / TB

Psoas abscess

Question 22

Causes of mild splenomegaly?

Answer 22

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