Abdominal Flashcards
Differentiating Caput Medusae from IVC obstruction
Compress below umbilicus
● Caput medusa: towards legs
● IVC obstruction: towards heart
Causes of hepatomegaly
- Massive
a. Metastases
b. Alcoholic liver disease with fatty infiltration
c. Myeloproliferative disease
d. Right heart failure
e. Hepatocellular cancer/secondary metastasis - Moderate
a. Haemochromatosis
b. Haematological disease – chronic leukaemia, lymphoma,
c. Fatty liver – secondary to diabetes mellitus, obesity, toxins
d. Infiltration – e.g. amyloid - Mild
a. Hepatitis
b. Biliary obstruction
c. Hydatid disease
d. HIV infection
By cause:
Liver - HCC, liver mets, AFLD, NAFLD, haemochromatosis, biliary obstruction, budd chiari.
Cardiac - RHF
Haematological - myloproliferative disease, CML, CLL, lymphoma.
infective - hepatitis, hydatid disease, HIV.
infiltrative - amyloid, gauchers
Causes of a firm and irregular liver
● Hepatocellular carcinoma
● Metastatic disease
● Cirrhosis
● Hydatid disease, granuloma (e.g. sarcoid), amyloid, cysts
Causes of a tender liver
● Hepatitis ● Rapid liver enlargement – e.g. right heart failure, Budd-Chiari syndrome (hepatic vein thrombosis) ● Hepatocellular carcinoma ● Hepatic abscess ● Biliary obstruction/cholangitis
Causes of a pulsatile liver
● Tricuspid regurgitation
● Hepatocellular cancer
● Vascular abnormalities
Causes of Hepatosplenomegaly.
- Chronic liver disease with portal hypertension
- Haematological: e.g. myeloproliferative disease, lymphoma, leukaemia, thalassaemia, sickle cell anaemia
- Infection, e.g. acute viral hepatitis, EBV, CMV
- Infiltration, e.g. amyloid, sarcoid
- Connective tissue disease, e.g. systemic lupus erythematosus
- Acromegaly
- Thyrotoxicosis
Causes of high SAAG (>11g/L)
High gradient (>11g/L) ● Cirrhosis with portal hypertension ● Alcoholic hepatitis ● Budd-Chiari syndrome ● Fulminant hepatic failure ● Congestive heart failure, constrictive pericarditis ● Myxoedema
Causes of Low SAAG (<11g/L)
Low gradient (<11g/L) ● Peritoneal carcinomatosis ● Tuberculosis ● Pancreatic ascites ● Nephrotic syndrome
Signs of liver disease
● Hands: leukonychia, clubbing, palmar erythema, bruising, asterixis
● Face: jaundice, scratch marks, spider naevi, fetor hepaticus
● Chest: gynaecomastia, loss of body hair, spider naevi, bruising, pectoral muscle wasting
● Abdomen: hepatosplenomegaly, ascites, signs of portal hypertension, testicular atrophy
● Legs: oedema, muscle wasting, bruising
Signs of decompensation
Synthetic - bile production, albumin production, clotting factor production.
Metatabolic - Macronutrient metabolism, bilirubin metabolism, drug and toxin metabolism (ammonia)
Signs of portal hypertension
● Splenomegaly
● Collateral veins
● Ascites
Causes of portal hypertension
- Cirrhosis of the liver
- Other causes
a. Pre-sinusoidal: portal vein compression, intravascular clotting, umbilical vein phlebitis
b. Intrahepatic: sarcoid, lymphoma or leukaemic infiltrates, congenital hepatic fibrosis
c. Post-sinusoidal: hepatic vein outflow obstruction (Budd-Chiari syndrome), veno-occlusive disease, constrictive pericarditis, chronic cardiac failure
Causes of Splenomegaly
- Infections: EBV, CMV, HIV, Malaria, Endocarditis
- Haematological: haemolytic anaemia, Polycythaemia vera, essential thrombocytosis, myelofibrosis, CML, CLL, lymphoma. thalassemia, sickle cell anaemia.
- Liver/Vascular: cirrhosis/portal hypertension, splenic vein thrombosis, Budd-Chiari syndrome
- Rheumatological: SLE, RA (Felty’s syndrome), Amyloidosis, Sarcoidosis
- Other - Gauchers disease
Causes of pancytopenia
● Aplastic anaemia: severe hypoplasia of the erythroid, myeloid and platelet precursor cell lines in the bone marrow resulting in a bone marrow that is fatty and empty of cells
● Marrow infiltration by leukaemia, lymphoma, carcinoma myeloma, myelofibrosis or granulomata
● Other: acute leukaemia, pernicious anaemia, hypersplenism, SLE, folate deficiency, PNH
Causes of anaemia
Microcytic anaemia
● Iron-deficiency anaemia
● Thalassaemia minor
● Sideroblastic anaemia
● Long-standing anaemia
Macrocytic anaemia
● Megaloblastic bone marrow due to Vitamin B12 deficiency or folate deficiency
● Alcohol
● Cirrhosis of the liver
● Reticulocytosis, e.g. haemolysis, haemorrhage
● Hypothyroidism
● Myelodysplastic syndrome
● Myeloproliferative disease
Normocytic anaemia
● Bone marrow failure
o Aplastic anaemia: drugs, radiation, SLE, viral hepatitis, pregnancy, Fanconi syndrome, idiopathic
o Ineffective haematopoiesis: myelodysplastic syndrome, paroxysmal nocturnal haemoglobinuria
o Infiltration: e.g. leukaemia, lymphoma, myeloma, granuloma, myelofibrosis
● Anaemia of chronic disease
o Chronic inflammation
o Malignancy
o Endocrine deficiencies, e.g. hypothyroidism, hypopituitarism, Addison’s disease
o Liver disease
o Chronic kidney disease
o Malnutrition
● Haemolytic anaemia
o Intracorpuscular defects: e.g. hereditary spherocytoiss, haemoglobinopathies – sickle cell, thalassaemia
o Extracorpuscular defects: e.g. AIHA, truma, MAHA, toxic (malaria)
Causes of polycythemia
● Idiopathic: polycythaemia rubra vera ● Secondary polycythaemia o Increased erythropoietin: ▪ Renal disease: polycystic disease, hydronephrosis, tumour, after renal transplantation ▪ Hepatocellular carcinoma ▪ Cushing’s syndrome o Hypoxic states ▪ Chronic lung disease ▪ Sleep apnoea ▪ Living at high altitude ▪ Cyanotic congenital heart disease ▪ Abnormal haemoglobins
