Abdominal Exam Flashcards
What are the causes of large kidneys?
- Unilateral
- -ADPKD
- -Hydronephrosis
- -Renal tumour
- -Congential (e.g. horseshoe) - Bilateral
- -ADPKD
- -Hydronephrosis
- -Bilateral tumour
- -Amyloid
- -Congenital renal anomalies
Causes of ESRF
Common causes
- Diabetic nephropathy
- ADPKD
- Hypertension
- Glomerulonephritis
- Connective tissue disease
Side effects of Ciclosporin
- Gum hypertrophy
- Hypertrichosis
- Skin malignancies
- HTN/fluid retention
- Hepatotoxic
- Hyperkalaemia/lipidaemia
Dose related:
- Tremor
- Nephrotoxic
Immunsuppressants in solid organ transplants
Corticosteroids Ciclosporin Tacrolimus Azathioprine Mycophenolate mofetil Sirolimus
Side effects of Azathioprine
Blood dyscrasias TB reactivation "Itis" -Pancreatitis -Interstitial nephritis -Hepatitis -Pneumonitis
Test for TPMT (thiopurine methyltransferase) as if patients defiecient - AZA not metabolised –> BM suppression
Side effects of Tacrolimus
Dose related Nephrotoxic Tremor Hepatotoxic CVS HTN Fluid retention Metabolic ↑K+ Hyperlipidaemia Skin Hypertrichosis Gum hypertrophy Photosensitivity Skin neoplasms
Causes of chronic liver disease
Common
- Alcohol
- Viral hepatitis (B/C)
- NAFLD
Congenital
- Biliary atresia
- Wilson’s
- Haemochromatosis
- Alpha1 antitrypsin
- CF
Acquired
- Autoimmune (PSC/PBC/AH)
- Drugs (MTX, amiodarone etc)
- Vascular (budd chiari, TR/RHD)
- Cryptogenic
Causes of acute liver failure (<28d)
Infectious
- Viral hepatitis A/B/D/E
- HSV/VZV/CMV/EBV
Drug
- Paracetamol
- Idiosyncratic - multiple (NSAID, anti-TB meds, OCP, ABx)
Vascular
- Ischaemia
- Budd chiari
Autoimmune (AH)
Pregnancy
- Acute fatty liver disease in pregnancy
- HELLP
Wilson’s
Malignant infiltration
What are the complications of a liver transplant?
Immediate
- Bleeding
- Very early graft failure
Early
- Biliary leak/strictures
- Infection (CMV, viral, fungal, sepsis)
- Vascular (HA thrombosis/stenosis, PV thrombosis, IVC stenosis)
- Acute rejection
- GVHD
Late
- Disease recurrence
- sdRenal failure
- HTN/DM
- Malignancy
- Osteodystrophy
- Chronic rejection
Causes of Leuconychia
Hypoalbuminaemia
Idiopathic
Hereditary
Drugs/toxins: sulphonamides, arsenic, heavy metal poisoning
Causes of Koilonychia
IDA Idiopathic Familial (nail patella syndrome) Physiological (neonates) Occupational Altitudinal
Peripheral signs of ESRF
Leuconychia
Half and Half nails
Mees’ lines (white lines, no pitting)
Beau’s lines (white lines, pitting)
Causes of clubbing
- Respiratory
- -Suppurative lung disease (bronchiectasis, empyema)
- -Pulmonary fibrosis
- -Lung cancer
- -Mesothelioma - Abdominal
- -IBD
- -Cirrhosis
- -Coeliac disease - Cardiac
- -Endocarditis
- -Atrial myxoma
- -Cyanotic heart disease - Other
- -Idiopathic/Familial (AD)
- -Thyroid acropachy
Causes of spider naevi
> 5 pathological
Normal in childhood Pregnancy OCP CLD Thyrotoxicosis
Causes of Abdominal distension
5 F’s:
- Fat
- Flatus
- Faeces
- Fluid
- Fetus
How do you differentiate the spleen from the kidney on examination?
- Kidney is ballotable
- Cannot get above spleen
- Spleen is dull to percussion
- Spleen has a notch
- Spleen moves with inspiration
Causes of pedal oedema
- Unilateral
- Venous obstruction
- Lymphatic obstruction - Bilateral
- Heart failiure
- Renal failure
- Hypoalbuminaemia
- Nephrotic syndrome
- Thyroid disease (myxodema)
What do you need to complete the abdominal examination?
- External genitalia/PR
- Hernial orifices
- Urine dip
- Fundi (if renal case)
Peripheral signs of liver disease
- Nails
- Leuconychia
- Clubbing - Hands
- Palmar erythema
- Dupuytren’s
- Asterixis - Arms
- Jaundice
- Bruising
- Excoriation
- Tattoos
Signs of Portal Hypertension
- Varices on endoscopy
- Splenomegaly
- Caput medusa
- Ascites
What indicates decompensated chronic liver disease?
- Jaundice
- Encephalopathy (asterisks)
- Variceal bleed
- Ascites
- Coagulopathy (bruising)
- Hepatorenal syndrome
- Hepatopulmonary syndrome
Grading of hepatic encephalopathy
0 - Mild memory/mentation disturbance
1 - Mild confusion/depression/euphoria
2 - Drowsy, mild disorientation for time, personality change
3 - somnolent but rousable, grossly confused, speech incomprehensible
4 - comatose
*Asterixis present in 2/3/4
What is Hepatorenal syndrome?
Severe splanchnic vasodilatation: o ↓Venous return o ↓CO o ↓effective arterial volume o ↑renal arterial vasoconstriction
Type 1 - Rapid onset
Type 2 - Gradual onset
How do you manage ascites in CLD?
- Reduced salt diet
- Spironolactone (100-400mg)
- Furosemide 2nd
- Therapeutic paracentesis
- TIPPS
- Liver Tx
What is included in the Child-Pugh Score?
A – Albumin B – Bilirubin C – Clotting (INR) D – Distension E – Encephalopathy
Grade A to C
What are the causes of ascites?
SAAG >11g/dL
- Cirrhosis
- Heart failure
- Hypoalbuminaemia
SAAG <11g/dL
- Malignancy
- TB
- Serositis in autoimmune disease
- Pancreatitis
What are the causes of hepatomegaly?
Common:
- Cirrhosis
- Cancer
- Cardiac failure
Others: Infective -Glandular fever -Viral hepatitis Infiltrative -Sarcoid -Amyloid -Haemochromatosis
Lympho/myeloproliferative disorders
What causes splenomegaly?
- Massive splenomegaly
- CML
- Myelofibrosis
- Kala-azar/visceral leishmaniasis
- Malaria - Non-massive
- Myeloproliferative
- Lymphoproliferative
- Portal HTN from CLD
- Congestive (RHF)
- Infective (mononucleosis, malaria, endocarditis, brucella)
- Autoimmune (felty, SLE)
- Infiltrative (sarcoid/amyloid)
