Abdominal Exam Shorts

Question 1

Causes of Isolated Hepatomegaly

Answer 1

1. Cirrhosis - NASH or ETOH liver disease
2. Congestion - RHF
3. Cancer - Primary HCC, Metastatic disease (CRC)
4. Infective - Hepatitis viruses, EBV/CMV, Abscesses (Pyogenic or Amoebic)
5. Infiltrative conditions - Sarcoidosis, Amyloidosis
6. Vascular - Budd chiari, Sickle cell

Question 2

Causes of Cirrhosis

Answer 2

1. Infective - Hepatitis B/C
2. Toxins - ETOH, Drugs (MTX or Amiodarone)
3. Metabolic - NASH or Inherited (Haemachromotosis or Wilsons disease)
4. Autoimmune - PBC, PSC, AIH
5. Congestion - RHF

Question 3

Describe the Manifestations and clinical signs of Cirrhosis

Answer 3

1. Portal HTN - Caput Medusa, Varicies (UGIB)
2. Altered Sex hormone metabolism - Gynecomastia, Spider Naevi
3. Coagulopathy (Decreased synthesis) + Hypersplenism due to Portal HTN (Thrombocytopaenia) - Petetchia and easy bruising
4. Hypoalbuminaemia - Fluid OL - Ascites or other, Leukonycia
5. Ammonia accumulation - Asterixis

Question 4

CLD case: How would you investigate further

Answer 4

Blood tests

• FBC - Anaemia and Thrombocytopaenia
• LFT - assess for any derangements
• Other markers of synthetic liver function: Albumin, Platelets, Coags, Bilirubin
• EUC - assess for potential hepatorenal syndrome
• Liver screen - Auto-antibodies, Hepatitis Serology
• Abdominal USS +/- Fibroscan

Question 5

Causes of Ascites

Answer 5

1. Cirrhosis (Portal HTN)
2. CCF
3. Infection: TB
4. Other causes of Hypoalbuminaemia - Nephrotic syndrome, Malnutrition
5. Malignancy

Question 6

What is the criteria used in abdominal paracentesis to help guide diagnosis?

Answer 6

Serum albumin ascites gradient

>11 = Transudate (Cirrhosis or CCF)

Question 7

Splenomegaly (+/- Hepatomegaly): Causes

Answer 7

1. Haematological causes
   - Myeloproliferative: Primary myelofibrosis, CML
   - Lymphoproliferative (Although would expect concurrent LN): Lymphoma or CLL
   - Haemolytic anaemia
2. Other causes
   - Portal HTN - Cirrhosis
   - Infective - EBV/CMV, HIV, Endocarditis
   - Infiltrative - Sarcoidosis, Amyloidosis
   - Autoimmune - RA (Felty), SLE

Question 8

What are the associations with PCKD

Answer 8

Hepatic cysts - Hepatomegaly
Berry Aneurysms - Prior strokes, CN palsies
CV Valve disease - MVP or AR

Question 9

What constitutes the Child-Pugh Score

Answer 9

2 Clinical

• Ascites
• Encephalopathy

3 Biochemical

• PT or INR
• Bilirubin
• Albumin