Abdomen Flashcards
How do you differentitiate splenomegaly from a kidney?
The spleen has no palpable upper border (the kidney does)
The spleen moved inferomedially on inspiration (the kidney doesn’t)
The spleen has a notch (the kidney doesn’t)
There is no resonance to percussion over a splenic mass (there is over the kidney)
The spleen is not ballotatable (the kidney is)
A friction rub can sometimes be heard over the spleen
What is a normal liver span?
Normal liver span is 12cm (11-14cm)
Mildly enlarged 12-15cm
Moderately enlarged 15-20cm
Massively enlarged is >20cm
Spiel for nomral liver findings?
The liver edge was regular, smooth, soft and non-tender and measured [11-14cm]. It was not pulsatile or ptosed.
What is a normal liver span?
11 - 14 cm.
What size is massive hepatomegaly and what are the causes?
A span > 20 cm is massive hepatomegaly.
Malignancy
Hepatoma
Metastases from another primary
Myeloproliferative disorders: myelofibrosis, dysplasia, CML
Hepatic pathologies
Hepatoma
Other
Tricuspid regurgitation (pulsatile hepatomegaly)
What size is moderate hepatomegaly and what are the causes?
A span of 15 - 20 cm is moderate hepatomegaly.
Malignancy
Myeloproliferative: Myelofibrosis / myelodysplasia / CML
Liver metastases
HCC
Primary liver pathologies
NAFLD
Haemachrmatosis
What are the sizes of splenomegaly?
1-2 cm mild splenomegaly
3-7 cm moderate splenomegaly
>7cm marked splenomegaly
What are the sizes and causes of marked splenomegaly?
>7cm = marked splenomegaly
Malignancy
Myelofibrosis, CML, Myelodysplasia
What are the sizes and causes of moderate splenomegaly?
3-7 cm = moderate splenomegaly
Malignancy
Myeloproliferative disorders: myelofibrosis, dysplasia, CML, PRV
Lymphoma, CLL
Hepatic
Portal HTN (with CLD liver may be small)
What causes hepatosplenomegaly?
Cirrhosis is usually = small liver + splenomegaly
NAFLD, EtOH liver disease, haemachromatosis, HCC causes hepatosplenomegaly
or
infiltrative diseases (lymphoma, amyloid, CTDs)
or
haematological malignancies (myelofibrosis / dysplasia) causes massive hepatosplenomegaly
What are the signs of portal hypertension?
Splenomegaly
Ascites
Prominent paraumbillical veins
History of oesophageal / rectal varicies
What are the peripheral stigmata of EtoH related liver disease?
Dupuytren’s contracture
Parotidomegaly
What are the sizes and causes of mild splenomegaly?
1-2 cm = mild splenomegaly
Malignancy
Myeloproliferative disorders: myelofibrosis, dysplasia, CML, PRV, ET
Lymphoma, CLL
Hepatic
Portal HTN (with CLD liver may be small)
Other
CTDs (RA)
ITP, Thalassaemia, Sickle Cell
Sarcoid, Amyloid
How do you differentiate splenomegaly from a left renal mass
Spleen
- Moves inferiorly and medially on inspiration
- Not ballotable
- Notch in upper margin (if moderate splenomegaly), and can’t get above
- Dullness in Traube’s space
Renal mass
- Moves inferiorly on inspiration
- Ballotable
- No notch, and can’t get above
- No dullness in Traube’s space
How to present exam findings of liver pathology.
Broad signs of CLD
Cachexia
Clubbing
Leuchonycia
Palmar erythema / Spider naevi (count the number)
Gynaecomastia / loss of body hair
Anaemia (conjunctival pallor and pale palmar creases)
Brusing
Jaundice / scleral icterus
Signs of decompensated liver disease
Jaundice
Ascites / SBP
Hepatic encephalopathy
HCC
HRS
HPS
Or state there is no evidence of decompensation
Signs of portal HTN
Ascites
Splenomegaly
Caput medusae / enlarged paraumbilical veins
In regard to the aetioloigy of the underlyig CLD
EtOH: Dupetryn’s / Parotidomegaly / tremor / Cerebellar syndrome / Peripheral neuropathy
Hep B / C: tatoos, IVDU
PBC: xanthelasma, zanthomata
Haemochromatosis: bronze pigmentation, arthropathy and 2nd and 3rd MCPJ
CCF: tricuspid reugrigitation
Wilson’s: KF rings (only seen on slit lamp!)
Alpha 1 anti-trypsin: signs of COPD
Presenting renal findings on exam:
Non-ballotable kidney and signs of RRT (fistula or transplant)
Ballotable kidney with or without signs of RRT
Aetiology of CKD
Renovascular disease: body habitus, hypertensive
Diabetes if finger pricks / insulin pumps / lipohypertrophy from insulin
Ballotable masses (PCKD)
Vasculitis: vasculitisc skin rash
CTDs: systemic sclerosis
Treatment of CKD
AVF
Tenkhoff catheter
- Functioning or non-functioning*
- Infected or not infected*
Complications of CKD / Adequacy of Renal Replacement Therapy
Asterixis / Altered mental status or encephalopathic
Fluid overload / HTN
Sallow skin complecion / Pruritis / brusing
Pericardial rub
Pale conjunctivae / palmar creases anaemia
Tachypnoea to compensate for metabolic acidosis
Renal Transplant
Transplant tenderness
Complications of immunosupression:
- stigamata of infection
- presence of skin lesion
- cyclosporin: gum hypertrophy,, hirsuitism, tremor
- steroids: cushingoid*
What to examine at the end of PCKD exam?
BP
Neurological exam - cerbeal aneurysms
Cardiac exam - MVP and AR
Respiratory exam - sign of fluid overload
What else to ask for at the end of a renal abdomen exam?
Weight
Urinalysis - haematuria, proteinuria
Cardiac exam - MVP/AR associated with PCKD, pericardial rub
Respiratory exam - sign of fluid overload
Lower limb exam - oedema, or peripheral neuropathy associated with uraemia
What is a normal liver span?
11 - 14 cm.
What size is massive hepatomegaly and what are the causes?
A span > 20 cm is massive hepatomegaly.
Malignancy
Hepatoma
Metastases from another primary
Myeloproliferative disorders: myelofibrosis, dysplasia, CML
Hepatic pathologies
Hepatoma
Other
Tricuspid regurgitation (pulsatile hepatomegaly)
What size is moderate hepatomegaly and what are the causes?
A span of 15 - 20 cm is moderate hepatomegaly.
Malignancy
Myeloproliferative: Myelofibrosis / myelodysplasia / CML
Liver metastases
HCC
Primary liver pathologies
NAFLD
Haemachrmatosis
What are the sizes of splenomegaly?
1-2 cm mild splenomegaly
3-7 cm moderate splenomegaly
>7cm marked splenomegaly
What are the sizes and causes of marked splenomegaly?
>7cm = marked splenomegaly
Malignancy
Myelofibrosis, CML, Myelodysplasia
What are the sizes and causes of moderate splenomegaly?
3-7 cm = moderate splenomegaly
Malignancy
Myeloproliferative disorders: myelofibrosis, dysplasia, CML, PRV
Lymphoma, CLL
Hepatic
Portal HTN (with CLD liver may be small)
