Abdominal swelling ΔΔ

Question 1

ΔΔ hepatomegaly?

Answer 1

• *chronic: ALD, NASH, right HF
• inflammation: viral or AI hep, PBC
• CA: HCC, lymphoma, leukaemia
• myeloproliferative: myelofibrosis, polycythaemia

Question 2

ΔΔ splenomegaly?

Answer 2

• CA: lymphoma, CML, liver mets
• portal hypertension
• inflammatory (EBV, endocarditis, malaria, leishmaniasis, brucellosis, TB, hepatitides, RA, SLE)
• myeloproliferative
• *haemolytic anaemia
• Gaucher’s disease (genetic lysomomal storage disease)

Question 3

ΔΔ hepatosplenomegaly?

Answer 3

liver
• cirrhosis
• portal HT

infection
• viral hep
• EBV
• CMV
• brucellosis
• malaria

blood
• + lymphadenopathy = lymphoma
• otherwise myeloproliferative
• anaemia (sickle cell, thalassaemia, pernicious)

other
• amyloidosis
• acromegaly
• SLE
• sarcoidosis

Question 4

ΔΔ distension? (5 Fs)

Answer 4

Fat
Fluid
Faeces
Flatus
Fetus

Question 5

ΔΔ RIF masses?

Answer 5

• appendix
• caecal CA
• Crohn’s
• pelvic
• intussusception
• TB
• amoebic
• actinomycosis (GRAM +ve bac)
• transplanted kidney/malformation
• undescended testis tumour

Question 6

ΔΔ LUQ mass?

Answer 6

• splenomegaly
• pancreatic cyst
• stomach/kidney/colon
• (neurofibroma)

Question 7

ΔΔ smooth hepatomegaly?

Answer 7

• hep
• CCF
• sarcoid
• early ALD

Question 8

ΔΔ craggy hepatomegaly?

Answer 8

• secondaries or 1’ hepatoma

Question 9

Ex: distension with dull percussion +/- shifting dullness?

Answer 9

fluid:
• ascites, from cirrhosis or malignancy, look for shifting dullness +/- fluid thrill
• distended bladder (can’t get below it)
• AAA (expansile)

fluid can also be sequestered in bowel like in obstruction/ilues

Question 10

Hx Qs to ascertain ΔΔ distension?

Answer 10

• last period (fetus)
• last bowel movement (faeces)
• Hx liver disease (fluid)
• recent surgery (flatus)

Question 11

causes of ascites?

Answer 11

• CA
• infection (TB)
• ↓ A-
• CCF (pericarditis)
• pancreatitis
• myxoedema

+ portal HT?
• cirrhosis
• Budd-Chiari (hepatic vein thrombosis)
• IVC/portal vein thrombosis

Question 12

Ix ascites?

Answer 12

aspirate ascitic fluid
• cytology
• culture
• albumin
\+ US

Question 13

ΔΔ splenomegaly + fever?

Answer 13

• infection (malaria, EBV, hep, etc…)
• sarcoid
• malignancy

Question 14

ΔΔ splenomegaly + lymphadenopathy?

Answer 14

• lymphoma, leukaemia
• EBV
• Sjogrens

Question 15

ΔΔ splenomegaly + arthritis?

Answer 15

• Sjogrens
• RA
• SLE
• Lyme’s
• vasculitis/behcets

Question 16

ΔΔ splenomegaly + ascites?

Answer 16

• Ca

* portal HT

Question 17

ΔΔ splenomegaly + anaemia?

Answer 17

• sickle cell
• thalassaemia
• pernicious
• leukaemia

Question 18

ΔΔ splenomegaly + ↓weight + CNS Sx?

Answer 18

• CA
• lymphoma
• TB
• arsenic poisoning

Question 19

ΔΔ splenomegaly + purpura?

Answer 19

• sepsis, DIC

* meningitis

Question 20

ΔΔ splenomegaly + murmur?

Answer 20

• endocarditis

* rheumatic fever

Question 21

ΔΔ MASSIVE splenomegaly?

Answer 21

• malaria
• myelofibrosis, CML
• Gauchers (genetic)

Question 22

ΔΔ MASSIVE splenomegaly?

Answer 22

• malaria
• myelofibrosis, CML
• Gauchers (genetic)
• leishmaniasis

Question 23

Ix lumps?

Answer 23

BEDSIDE:
• pregnancy test
• mantoux

BLOODS:
• FBC and film (malaria, EBV), U+E, LFT
• Ca+ (pancreatitis - ascites)
• tumour markers if appropriate

IMAGING:
• US
• CT +/- biopsy
• MRI (liver mass)