DrE: Abdomen Flashcards
What are the stages of clubbing?
- Congestion
- Loss of angulation
- Increased AP diameter
- Drumsticking
What are the causes of clubbing?
- Gastrointestinal:
- Cirrhosis - PBC
- Inflammatory bowel disease - crohns
- Malabsorption - coeliac disease
- GI lmphoma
- Respiratory
- Chronic suppurative - CF, abscess, bronchiectasis, empyema
- Intestitial disease - ideopathic fibrosis
- Non-small cell Ca - bronchial carcinoma
- Mesothelioma
- Sarcoidosis
- Cardiovascular:
- Infective endocarditis
- Cyanotic congenital heart disease
- Atrial myxoma
- ToF
- Other:
- Graves - autoimmune hyperthyroidism - thyroiid acropachy
- Familial - pseudoclubbing
- Unilateral:
- Axillary artery aneurysm
What is dyspagia?
Difficulty swallowing
What are the causes of dysphagia?
- Congenital: oesophageal atresia
- Acquired:
- Luminal
- Food bolus
- Foreign body
- Oesophageal web
- Plummer Vinson syndrome (assoc Fe def)
- Intramural:
- Achalasia - increased risk of Ca
- Carcinoma
- GORD
- Oeophagitis
- Oesophageal dysmotility
- Scleroderma
- Stricture e.g. radiation
- Extramural:
- Hilar lymphadenopathy
- Pharyngeal pouch
- Retrosternal goitre
- Lung Carcinoma
- Neurological:
- Stroke
- Myasthenia gravis
- Motor Neuron Disease
- Other
- Stomatitis
- Glossitis
- Tonsillitis
- Pharyngitis
- Luminal
What is odynophagia?
Pain on swallowing
Barium swallow
1) Apple core - oesophageal Ca
2) Achalasia - bird’s beak
3) Oesophageal web
What are the causes of Odynophagia?
- Trauma: pharyngeal trauma, radiation, oesophageal burn, mallory-weiss syndrome, ruptured oesophagua
- Foreign body: oropharengeal/pharyngeal
- Infection: pharyngitis, tonsillitis, osphagitis (HSV, candida), abscess
- GORD: oesophagitis, ulceration
- Neoplasia: pharyngeal, laryngeal, oesophageal carcinoma
- Motility: achalasia, oesophageal dysmotility syndromes
- Neurological: stroke, myasthenia gravis, MND
- Other: plummer Vinson, pharyngeal pouch, sleroderma
Causes of osophageal mass?
- Skn and soft tissue:
- cyst
- lipoma
- sarcoma
- GI:
- Epigastric herna
- Gastric carcinoma
- Pancreatic carcinoma
- Pancreatic pseudocyst
- Vascular:
- AAA
- Lymphadenopathy
What are the causes of hepatomegaly?
- Physiological:
- Riedel’s lobe
- hyperexpanded chest
- Infective
- Viral: hepatitis, EBV, CMV
- Bacterial: TB, abscess
- Protozoal: malaria, schistosomiasis (protozoa)
- Malignant:
- Primary/secondary
- Lymphoma
- Leukaemia
- Alcohol:
- Fatty liver/crrhosis
- Metabolc:
- Amyloid
- Hereditary haemochormatosis
- Wilson’s disease
- Congestive
- Right heart failure
- Tricuspid regurgitation (pulsatile liver)
- Budd chiari syndrome
What are the most common causes of hepatomegally in the UK?
- Malignancy:
- primary/secondary, haemotological (CML)
- Alcohol related:
- Fatty liver disease, alcoholic hepatitis
- Infective:
- Viral - Hep ABC, EBC
- Bacterial - liver abscess
- Parasitic - malaria
What is Budd Chari Syndrome?
hepatic vein obstruction e.g. thrombosis/carcinoma
Upper abdo pain, jaundice, hepatomegally, ascitis
LFTs deranged
Progress to encephalopathy
What are the causes of cirrhosis?
- Congenital:
- HHC
- Wilsons
- Alpha 1 antitripsin deficiency
- Autoimmune
- Autoimmune hepatitis
- Biliary:
- Primary Biliary Cirrhosis (PBC)
- Primary Sclerosis Cholangitis
- Cardiac
- CCF
- Drugs:
- ETOH
- Infectve:
- Hep B and C
- Schistosomiasis
- Other:
- Sarcoid
What is portal hypertension?
Portal vein pressure >10mmHg
What are the causes of portal hypertension?
- Pre-hepatic:
- Portal vein thrombosis
- Splenic vein thrombosis
- Splenic arterio-venous fistula
- Hepatic
- Cirrhosis
- Sarcoid
- Schistosomiasis
- Post hepatic:
- Budd-Chiari syndrome
- Constrictive pericarditis
- Right heart failure
What are caput medusae?
Distended, engorged perumbilcal veins
due to severe portal hypertension
with porto-systemic shunting of bloods through the umbilical veins
What are the causes of distended umblical veins?
- Physiological
- Portal hypertension leading to porto-systemic shunting - blood flow central to distal
- IVC obstruction - blood flow inferior - to- superior
What is ascitis?
Fluid in the peritoneal cavity
What are the causes of ascitis?
- Transudate (Protein <30g/L)
- Cirrhosis
- nephrotic syndrome
- CCF
- Pericarditis
- Exudate
- Inflammation e.g. pancreatitis
- Infection e.g. TB
- Malignancy e.g. primary/secondary
How would you investigate ascitis?
- Blood tests
- FBC, U&E, LFT, CRP, Coagulation, (group and save?)
- Diagnostic paracentesis:
- microbiology: MC&S
- Cytology: malignant cells
- Biochemistry: Protein, glucose, amylase
- Serum ascites albumin gradient
- difference <1.1 = exudate, >1.1 = transudate
- USS
- Intra-abdominal organs, extent of ascites, (guide drainage)
- Doppler
- portal vein flow, budd-chiari syndrome, portal vein thrombosis
- Abdo CT
- details inta abdo organism
What are the treatment opertions for ascites?
- Conservative:
- Salt restriction
- Water restriction - if hyponatraemic
- Weight monitoring - weight loss of no more than 0.5Kg/day (if ascites alone), 1Kg/day if peripheral oedema
- Medical:
- Rx cause
- Diuretics: spironolactone
- Surgical:
- Paracentesis - diagnostic/therapeutic
- TIPS - Transjugular intrahepatic portosystemic shunt (pt with advanced cirrhosis and recurrent ascites)
- LeVeen Peritoneovenous shunt - drains ascites directly into venous circulation connecting peritoneal cavity to SVC/IJV via 1 way valve (prevents backflow)
- Complication: fluid overload, shunt blockage, bacterial colonisation
- Liver transplant: end stage liver disease