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Internal Medicine > Abdomen > Flashcards

Abdomen Flashcards

1
Q

No movement with respiration

A

Peritonitis

Paralysis

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2
Q

Visible pulsation

A

Aortic aneurysm

Vascular tumor??

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3
Q

Visible peristalsis

A

GI obstruction

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4
Q

Mass characterization

A 
Site
Size
Shape
Edge
Mobility (with respiration, by hand)
Consistency
Fixation (to skin, to deep structures)
Pulsation
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5
Q

Distended vessels

A

Upward: PHTN (caput Medusa), inferior vena cava obstruction

Downward: superior vena cava syndrome

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6
Q

Ascites ddx

A 
Portal vein thrombosis 
Splenic vein thrombosis 
Cirrhosis 
Schistosomiasis 
ALF
Primary biliary cholangitis 
Veno-occlusive syndrome (sinusoidal obstruction)

HF
Constructive pericarditis
Budd Chiari syndrome
IVC obstruction

Nephrotic syndrome 
Malnutrition 
Malignancy 
TB 
Pancreatitis
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7
Q

Hernial sites

A

Epigastric
Umbilical
Inguinal
Femoral

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8
Q

Normal bowel sound range

A

5-34 per minute

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8
Q

Bruit

A

Aortic
Renal arteries
Iliac arteries
Over organs (liver, spleen)

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9
Q

Splenic percussion techniques

A

Traube’s space
Castell’s method
Nixon’s method

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10
Q

Ddx of ascites

A 
Portal hypertension: 
Cirrhosis
Portal vein thrombosis
Schistosomiasis 
Acute liver failure
Heart failure 
Constrictive pericarditis 
Inferior vena cava obstruction

Non PHTN:
Nephrotic syndrome (osmotic)
Malnutrition
Malignancy
Tuberculosis
Pancreatitis (pancreatic secretions collect in the peritoneum die to pancreatic duct injury)
Chylous ascites (leakage of lymph into peritoneal cavity or increased peritoneal lymphatic pressure secondary to obstruction)

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11
Q

Ddx of splenomegaly

A 
Malaria
Typhoid fever
Viral hepatitis 
Portal hypertension 
Lymphoma 
Leukemia 
Myelofibrosis
Hemolytic anemia
Military TB
SLE
IE
Infectious mononucleosis 
Kalazar 
Sarcoidosis
Toxoplasmosis 
Bartonella (cat scratch disease)
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12
Q

Ddx of hepatomegaly

A 
Acute hepatitis (viral, drug induced, alcoholic)
CLD
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13
Q

Hepatosplenomegaly

A 
Advanced CLD
TB
Malaria
Leukemia
Thyroid fever
Visceral leishmaniasis (kala-azar)
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14
Q

Splenomegaly with ascites

A

CLD
TB
Lymphoma
Leukemia

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15
Q

Ascites definition

A

Accumulation of >25ml of fluid in the peritoneal cavity

Normal: 5-20ml

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16
Q

Abdominal tap (paracentesis)

A

50-100 ml fluid tapped

2-3 cm below umbilicus
2-4 cm superomedial to ASIS

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17
Q

Peritoneal fluid analysis

A

Chemical
Bacteriological
Cellular

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18
Q

SAAG

A

Serum albumin con. - Ascitic fluid albumin con.

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19
Q

High SAAG

A

Greater than or equal to 1.1mg/dL

Cirrhosis (80% of cases)
Alcoholic hepatitis
Heart failure 
Portal vein thrombosis
Budd-Chiari syndrome: obstruction of hepatic venous outflow
Schistosomiasis 
Congenital hepatic fibrosis
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20
Q

Low SAAG

A

<1.1 mg/dL

TB
Peritoneal malignancy 
Pancreatitis 
Pyogenic peritonitis (infection of ascitic fluid)
Nephrotic syndrome
Pseudomyxoma peritonei
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21
Q

Budd-Chiari syndrome

A

Obstruction of hepatic venous outflow

22
Q

Hepatocellular cancer screening

A 
Ultrasound 
AFP test (alpha fetoprotein): produced whenever liver cells are regenerating
23
Q

Cirrhosis

A

Fibrosis and scarring of the liver. Healthy liver cells are replaced with inflammatory cells and fibrous tissues.

24
Q

Portal triad

A 
Portal vein (blood from GI)
Hepatic artery (blood supply of the liver) 
Bile ductules
25
Q

Ligament of Treitz (suspension ligament of duodenum)

A

Extension form right crus of diaphragm
Duodenojejunal junction
Boundary between upper and lower GI

26
Q

Hepatic encephalopathy

A

Decline in brain function due to a buildup of toxins in the bloodstream in patients with chronic liver disease

27
Q

Hepatopulmonary syndrome

28
Q

Hepatorenal syndrome

29
Q

Causes of cirrhosis

A

Alcoholic cirrhosis
Chronic viral hepatitis (HBV, HCV)
Cardiac cirrhosis
Biliary cirrhosis
Non alcoholic steatohepatitis (advanced form of NAFLD)
Inherited metabolic LD: hemochromatosis, Wilson’s disease, cystic fibrosis, alpha-1 antitrypsin deficiency
Cryptogenic fibrosis

30
Q

Non hepatotropic viral causes of hepatitis

A 
CMV
EBV
HSV
Varicella 
Mumps
Yellow virus 
Adenovirus
31
Q

Enteric hepatotropic virus

32
Q

Albumin is synthesized by

33
Q

Yellowish discoloration

A

Jaundice
Carotenodema (does not cause icteric sclera!!)
Quinacrine
Phenol exposure

34
Q

GI cause of clubbing

A

IBD (CD, UC)
Malabsorption
GI lymphoma
Liver cirrhosis

35
Q

Traube’s space

36
Q

Parasitic causes of hepatomegaly

A

Amoebic liver abscess
Echinococcus granulosus
Leishmaniasis

37
Q

Bacterial causes of hepatomegaly

A

TB
Thyphoid fever
Pyogenic liver abscess

38
Q

Malignant causes of hepatomegaly

A

Hepatoma (hepatocellular carcinoma)
Metastasis
Lymphoma
Leukemia

39
Q

Metabolic causes of hepatomegaly

A

DM

Glycogen storage disease

40
Q

Congestive hepatomegaly

A

Right side heart failure
Constrictive pericarditis
Pericardial effusion
Budd-chiari syndrome

41
Q

Tender hepatomegaly

A 
Advanced CLD
TB
Malaria
Leukemia 
Thyphoid fever 
VL
42
Q

Splenomegaly with ascites

A

CLD
TB
Lymphoma
Leukemia

43
Q

Massive splenomegaly ddx

A 
Chronic malaria 
Chronic myeloid leukemia (CML)
Myelofibrosis
Kalazar 
Hairy cell leukemia
VL
44
Q

Massive splenomegaly is

A

> 8cm below costal margin or >1000 gm on US

45
Q

Ascites definition

A

> 25 ml of fluid in the peritoneal cavity

46
Q

Chemical analysis of peritoneal fluid

A

Protein
Amylase
Triglyceride
Glucose

47
Q

Bacteriological analysis of peritoneal fluid

A

Gram stain
AFB
Culture

48
Q

Cellular analysis of peritoneal fluid

A

WBCs (>250/microL PMN: Bacterial)

Others

49
Q

Round ligament of the liver

A

Obliterated umbilical vein

50
Q

Prehepatic causes of hypertension

51
Q

Intrahepatic causes of hypertension

52
Q

Posthepatic causes of hypertension

Internal Medicine (10 decks)

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