Abdominal exam Flashcards
Massive hepatomegaly
Metastases Right heart failure Hepatocellular carcinoma Alcoholic liver disease with fatty infiltration Myeloproliferative disease
Moderate hepatomegaly
Fatty liver- obesity, DM
CML, lymphoma
Haemochromatosis
Mild hepatomegaly
Hepatitis Cirrhosis Biliary obstruction Granulomatous disorders Hydatid disease Amyloidosis and other infiltrative disease HIV infection Ischaemia
Firm and irregular liver
Cirrhosis
Metastatic disease
Hydatid disease, granuloma, cysts, lipoidoses
Tender liver
Hepatitis
Rapid liver enlargement- RHF, Budd-Chiari syndrome
Hepatocellular carcinoma
Pulsatile liver
Tricuspid regurgitation
Hepatocellular carcinoma
Vascular abnormalities
Bilateral renal masses
Polycystic kidneys Hydronephrosis or pyonephrosis Hypernephroma (bilateral renal cell carcinoma) Acute renal vein thrombosis Amyloid, lymphoma Acromegaly
Unilateral renal masses
Renal cell carcinoma Hydronephrosis or pyonephrosis Polycystic kidney- asymmetric Acute renal vein thrombosis Normal right kidney or solitary kidney
RIF masses
Appendiceal abscess Caecal carcinoma Crohn's disease Pelvic kidney Ovarian tumour/cyst Carcinoid tumour Amoebiasis Psoas abscess Ileocaecal tuberculosis
LIF masses
Faeces Carcinoma of sigmoid/descending colon Diverticular disease Ovarian tumour/cyst Psoas abscess
Upper abdominal masses
Retroperitoneal lymphadenopathy AAA Stomach carcinoma Pancreatic pseudocysts/tumour Transverse colon carcinoma
Massive splenomegaly
CML
Myelofibrosis
Malaria
Lymphoma of spleen, hairy cell leukaemia
Moderate splenomegaly
Portal HTN Lymphoma Leukaemia Thalassaemia Storage diseases- Gaucher's
Mild splenomegaly
Myeloproliferative disease Haemolytic anaemia Megaloblastic anaemia Infection- infectious mononucleosis, hepatitis, IE CT disease- RA, SLE, PAN Amyloidosis, sarcoidosis
Hepatosplenomegaly
Chronic liver disease with portal HTN
Haematological- Myeloproliferative disease (CML, myelofibrosis), lymphoma (CLL, marginal), sickle cell anaemia
Infection- Acute viral hepatitis, glandular fever, CMV
Infiltrative- Amyloidosis/sarcoidosis
Rheumatological- SLE
Endo- Acromegaly, thyrotoxicosis
Features of spleen compared to kidney
No palpable upper border Has a notch Moves inferomedially on respiration Usually no resonance over splenic mass Not ballotable Friction rub may be heard
Causes of generalised lymphadenopathy
Lymphoma (rubbery and firm) Leukaemia Malignant disease (firm) Infections- HIV, EBV, CMV, TB, brucellosis, toxoplasmosis RA, SLE Sarcoidosis Phenytoin
If jaundice present, perform
Abdo exam- check gallbladder tenderness, Courvoisier’s sign
Listen to heart- exclude mechanical heart valve
Lymphadenopathy- ?autoimmune haemolysis in setting of haem malignancy
Skin for purpura ?TTP
Causes of jaundice
Pre-hepatic: haemolysis (membrane defects, immune haemolysis, mechanical)
Hepatic: conjugation defects (Gilbert’s), excretion defect (Dubin-Johnson, Rotor syndrome), cirrhosis, hepatitis, liver metastases
Post-hepatic: gallstones, gallbladder/bile duct pathology, pancreatic pathology
Investigations for jaundice
LFTs Bilirubin + fractions Urinalysis- bilirubin Haemolysis studies- reticulocytes, haptoglobin, Coomb's Viral serology USS abdomen
Signs of haemochromatosis
Signs of CLD including asterixis Arthropathy in 2nd and 3rd MCPs Proximal myopathy Axillary hair Diabetic eyes Gynaecomastia, decreased muscle bulk Cardiomyopathy Ascites Testicular atrophy Peripheral oedema
Causes for ascites
Pre-hepatic: CHF, Budd-Chiari syndrome, IVC obstruction
Hepatic: decompensated cirrhosis with portal HTN
Intra-abdominal causes: nephrotic syndrome, TB peritonitis, chylous ascites, pancreatitis
Ix for ascites
Abdo USS
Paracentesis- diagnose cause, exclude infection
Ascitic fluid tests- cell count and differential, SAAG, total protein, culture, gram stain, cytology
Renal Tx other exam
Look for causes for transplant- DM, HTN, vasculitis (GN), PCKD (ballotable kidneys, nephrectomy scar), SLE
Complications of Tx- skin cancer, Cushing’s, hirsutism, gums
HTN
Infection- mouth, lungs
CVD/PVD
Lymphomas
Gouty tophi
Causes for decreased Hb levels
Bleeding Fe/B12/folate deficiency BM disorder Chronic disease Renal failure Haemolysis Thalassaemia Sickle cell
Causes of increased Hb levels
Hypoxia
Increased EPO
PRV
Causes of macrocytosis
Alcohol B12/folate Drugs Hypothyroidism Liver disease Bone marrow failure Pregnancy
Causes of thrombocytopenia
Decreased production- marrow/fibrosis/infiltration
Liver disease
Hypersplenism
Increased consumption- autoimmune (SLE, APS), infection (EBV, CMV), drugs (heparin, penicillin), ITP, DIC
PCKD clinical manifestations
Ballotable renal masses
Nephrectomy scars
Evidence of renal replacement- fistula, renal Tx
Hepatomegaly/splenomegaly- cysts
Evidence of anaemia
Mitral valve prolapse/AR
Berry aneurysm cranial scars
CN palsies- from PICA berry aneurysm
HTN
Findings of decompensated chronic liver disease
Impaired synthetic function- ascites, peripheral oedema, bruising
Catabolic dysfunction- jaundice, encephalopathy
Causes of decompensated chronic liver disease
Infection
Constipation
Non-compliance
Alcohol
Ascites
HCC
Portal vein thrombosis
GI bleeding
Clinical findings of compensated chronic liver disease
Palmar erythema
Clubbing
Leukonychia
Hair loss
Gynaecomastia
Spider naevi
Testicular atrophy
Features of malnutrition/RHF
Features of portal HTN
Splenomegaly
Caput medusae
Varices
