Abdominal Flashcards
Causes of cirrhosis?
Alcohol Non alcoholic fatty liver disease Infections (Hep B and C) Autoimmune (PBC, PSC, autoimmune hepatitis) Metabolic (hemochromatosis, Wilson's)
Causes of hepatomegaly?
Cirrhosis (alcohol, NAFLD, autoimmune)
Carcinoma (primary of secondary metastases)
Congestive cardiac failure
Infections (EBV, Hep B or C)
Infiltrative (amyloid or myeloproliferative disease)
What demonstrates decompensation of liver diseases?
asterixis
ascites
encephalopathy
investigations for patient with hepatomegaly
FBC, clotting, U&Es, LFTs and glucose
USS abdomen
ascitic tap
if cirrhosis proven; autoantibodies, hep B/C serology, ferritin, caeruloplsmin, alpha-1 antitrypsin, AFP
What autoantobodies are associated with autoimmune hepatitis?
anti - smooth muscle antibodies
What autoantibodies are associated with primary biliary cirrhosis?
anti-mitochondrial antibodies
Causes of ascites?
cirrhosis, carcinoma, CCF
Causes of gynaecomastia?
age Kleinfelter's cirrhosis drugs (spironolactone, digoxin) testicular tumour thyroid disease
What is the prognostic classification score for cirrhosis?
Child-Pugh classification
vitamin K is a cofactor for which coagulation factors?
II, VII, IX, X and for proteins C and S
Signs of haemochromatosis?
pigmented skin, signs of chronic liver disease, hepatomegaly, venesection, joint replacements, finger prick marks from CBG testing
Conditions associated with haemochromotosis other than chronic liver disease?
arthopathy due to pseudogout diabetes cardiomyopathy or cardiac conduction abnormalities hepatocellular carcinoma hypogonadism osteoporosis
What is the genetics of haemochromotosis?
autosomal recessive mutation on HFE gene on chromosome 6
How to investigate for haemochromotosis?
ferritin (increased) and transferrin saturation (increased), liver biopsy, genotyping, blood glucose, ECG, CXR, echo, , liver USS, AFP,
Causes of massive splenomegaly >8cm enlargement (>20cm total spleen); (name 3)
CML
myelofibrosis (primary or secondary due to polycythaemia ruba vera or essential thrombocytosis)
malaria
Most common causes of splenomegaly in UK, any size?
EBV
portal hypertension
myeloproliferative disease
Causes of moderate splenomegaly (4-8cm enlargement)?
Myeloproliferative disease (CML, myeofibrosis, Polycythaemia rubra vera, essential thrombocytosis) Lymphoproliferative disease (lymphoma, acute and chronic lymphocytic leukaemias, multiple myeloma) Infiltration (amyloidosis or Gaucher's disease)
Causes of mild spenomegaly (tip)?
Portal hypertension
Haemolytic anaemia
Infections (EBV, endocarditis, hepatitis)
myelo and lymphoproliferative disorders
Investigations for spelnomegaly
FBC, blood film, LFTs, USS abdomen CT chest and abdomen Bone marrow aspirate Lymph node biopsy Malaria films Viral serology
How should a splenectomy patient be managed?
Vaccination (ideally 2/52 before if planned)
pneumococcus, meningococcus, haemophilus influenza,
Prophylactic penicillin
Medic alert
Indications fora splenectomy
trauma
ITP
hereditary spherocytosis
Causes for single kidney enlargement
hydronephrosis
tumour
simple cysts
polycystic kidney disease
Causes of bilateral kidney enlargement
polycystic kidney disease bilateral renal cell carcinoma bilateral hydronephrosis amyloidosis tuberous sclerosis (renal angiolipomata and cysts)
Tuberous sclerosis - signs?
Ash leaf macules >6 periungal fibromas adenoma sebacecum on the face shagreen patches epilepsy
What is tuberous sclerosis?
genetic disorder causing hamartomas (skin, brian and kidneys). autosomal dominant. typically presents in childhood with epilepsy and typical skin changes
