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Clinical exam things > Abdominal exam > Flashcards

Abdominal exam Flashcards

1
Q

Massive hepatomegaly

A 
Metastases
Right heart failure
Hepatocellular carcinoma
Alcoholic liver disease with fatty infiltration
Myeloproliferative disease
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2
Q

Moderate hepatomegaly

A

Fatty liver- obesity, DM
CML, lymphoma
Haemochromatosis

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3
Q

Mild hepatomegaly

A 
Hepatitis
Cirrhosis
Biliary obstruction
Granulomatous disorders
Hydatid disease
Amyloidosis and other infiltrative disease
HIV infection
Ischaemia
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4
Q

Firm and irregular liver

A

Cirrhosis
Metastatic disease
Hydatid disease, granuloma, cysts, lipoidoses

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5
Q

Tender liver

A

Hepatitis
Rapid liver enlargement- RHF, Budd-Chiari syndrome
Hepatocellular carcinoma

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6
Q

Pulsatile liver

A

Tricuspid regurgitation
Hepatocellular carcinoma
Vascular abnormalities

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7
Q

Bilateral renal masses

A 
Polycystic kidneys
Hydronephrosis or pyonephrosis
Hypernephroma (bilateral renal cell carcinoma) 
Acute renal vein thrombosis
Amyloid, lymphoma
Acromegaly
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8
Q

Unilateral renal masses

A 
Renal cell carcinoma
Hydronephrosis or pyonephrosis
Polycystic kidney- asymmetric
Acute renal vein thrombosis
Normal right kidney or solitary kidney
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9
Q

RIF masses

A 
Appendiceal abscess 
Caecal carcinoma
Crohn's disease
Pelvic kidney
Ovarian tumour/cyst
Carcinoid tumour 
Amoebiasis
Psoas abscess 
Ileocaecal tuberculosis
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10
Q

LIF masses

A 
Faeces
Carcinoma of sigmoid/descending colon
Diverticular disease
Ovarian tumour/cyst
Psoas abscess
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11
Q

Upper abdominal masses

A 
Retroperitoneal lymphadenopathy
AAA
Stomach carcinoma
Pancreatic pseudocysts/tumour
Transverse colon carcinoma
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12
Q

Massive splenomegaly

A

CML
Myelofibrosis
Malaria
Lymphoma of spleen, hairy cell leukaemia

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13
Q

Moderate splenomegaly

A 
Portal HTN
Lymphoma
Leukaemia
Thalassaemia
Storage diseases- Gaucher's
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14
Q

Mild splenomegaly

A 
Myeloproliferative disease
Haemolytic anaemia
Megaloblastic anaemia
Infection- infectious mononucleosis, hepatitis, IE
CT disease- RA, SLE, PAN
Amyloidosis, sarcoidosis
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15
Q

Hepatosplenomegaly

A

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

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16
Q

Features of spleen compared to kidney

A 
No palpable upper border
Has a notch
Moves inferomedially on respiration
Usually no resonance over splenic mass
Not ballotable 
Friction rub may be heard
17
Q

Causes of generalised lymphadenopathy

A 
Lymphoma (rubbery and firm)
Leukaemia
Malignant disease (firm)
Infections- HIV, EBV, CMV, TB, brucellosis, toxoplasmosis
RA, SLE
Sarcoidosis
Phenytoin
18
Q

If jaundice present, perform

A

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

19
Q

Causes of jaundice

A

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

20
Q

Investigations for jaundice

A 
LFTs
Bilirubin + fractions
Urinalysis- bilirubin
Haemolysis studies- reticulocytes, haptoglobin, Coomb's
Viral serology
USS abdomen
21
Q

Signs of haemochromatosis

A 
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
22
Q

Causes for ascites

A

Pre-hepatic: CHF, Budd-Chiari syndrome, IVC obstruction

Hepatic: decompensated cirrhosis with portal HTN

Intra-abdominal causes: nephrotic syndrome, TB peritonitis, chylous ascites, pancreatitis

23
Q

Ix for ascites

A

Abdo USS
Paracentesis- diagnose cause, exclude infection
Ascitic fluid tests- cell count and differential, SAAG, total protein, culture, gram stain, cytology

24
Q

Renal Tx other exam

A

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

25
Q

Causes for decreased Hb levels

A 
Bleeding
Fe/B12/folate deficiency
BM disorder
Chronic disease
Renal failure
Haemolysis
Thalassaemia
Sickle cell
26
Q

Causes of increased Hb levels

A

Hypoxia
Increased EPO
PRV

27
Q

Causes of macrocytosis

A 
Alcohol
B12/folate
Drugs
Hypothyroidism
Liver disease 
Bone marrow failure
Pregnancy
28
Q

Causes of thrombocytopenia

A

Decreased production- marrow/fibrosis/infiltration
Liver disease
Hypersplenism
Increased consumption- autoimmune (SLE, APS), infection (EBV, CMV), drugs (heparin, penicillin), ITP, DIC

29
Q

PCKD clinical manifestations

A

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

30
Q

Findings of decompensated chronic liver disease

A

Impaired synthetic function- ascites, peripheral oedema, bruising

Catabolic dysfunction- jaundice, encephalopathy

31
Q

Causes of decompensated chronic liver disease

A

Infection
Constipation
Non-compliance
Alcohol
Ascites
HCC
Portal vein thrombosis
GI bleeding

32
Q

Clinical findings of compensated chronic liver disease

A

Palmar erythema
Clubbing
Leukonychia
Hair loss
Gynaecomastia
Spider naevi
Testicular atrophy
Features of malnutrition/RHF

33
Q

Features of portal HTN

A

Splenomegaly
Caput medusae
Varices

Clinical exam things (7 decks)

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