Gastro

Question 1

unknown abdominal mass

Answer 1

1. organ = liver, kidney, spleen
2. transplanted organ
3. tumour e.g. Wilm’s

Question 2

hepatomegaly DDx

Answer 2

SHHIIMM
Structural (choledochal cyst)
Heart
Haem (thal, sickle cell)
Infective
Inflammatory (AI)
Malignancy
Metabolic (storage, A1AT, Wilson’s)

Question 3

Liver transplant DDx - what causes cirrhosis?

Answer 3

1. biliary tree disfunction
2. chronic hepatitis
3. metabolic/genetic e.g. Wilson’s A1At

Question 4

Renal transplant DDx - what causes renal failure?

Answer 4

CIGS:
Cystic nephropathy e.g. nephronopthisis
Infection e.g HUS
Glomerulonephritides e.g. IgA mediated
Structural e.g. PUV

Question 5

Splenomegaly OR hepsplenomegaly DDx

Answer 5

PHIIMM
Portal HTN
Heart
Haem (thal, sickle cell)
Infective
Inflammatory (AI)
Malignancy
Metabolic (stoarge, A1AT, Wilson’s

Question 6

leukonychia vs koilonychia

Answer 6

leukonychia = low albumin
koilonychia = low Fe

Question 7

spider naevi ddx

Answer 7

1. chronic liver disease
2. HHT
3. Ataxia-telangectasia

Question 8

signs of chronic liver disease

Answer 8

jaundice
poor growth
palmar erythema, clubbing, asterixis
xanthoma, bruising
spider naevi
gynaecomastia
striae, ascites, caput medusae
hepatomegaly
oedema

Question 9

glossitis suggests what deficiency?

Answer 9

Iron, folate, B12 deficiency

Question 10

gum hypertrophy ddx

Answer 10

1. myeloid leukaemia
2. ciclosporin

Question 11

macroglossia ddx

Answer 11

1. hypothyroidism
2. Beckwidth-Wiedemann
3. metabolic: MPS, Pompe’s, GSD

Question 12

Types of scars at the abdomen

Answer 12

Groins – inguinal hernia repair, renal transplant (will also be palpable mass)

Below right subcostal margin – (Kocher’s incision) – think cholecystectomy, especially in sickle cell disease, any liver procedure, e.g. hemi-hepatectomy for hepatoblastoma

‘Rooftop scar’ – liver transplant

Transverse upper abdominal incision – repair of congenital diaphragmatic hernia – more common on the left

Upper abdominal midline incision – Nissen’s fundoplication

Small right upper transverse incision – Ramstedt’s pyloromyotomy

Umbilicus – consider gastroschisis or exomphalos, umbilical hernia repair

Laparoscopy scars – more common, very small and multiple (often one at umbilicus)

Lateral thoracolumbar incision – nephrectomy

Question 13

right vs left sided stoma suggest?

Answer 13

right stoma = ileostomy
left stoma = colonostomy

Question 14

mercedes benz scar =

Answer 14

liver transplant

Question 15

spleen vs kidney palpation - how to tell diff?

Answer 15

spleen can’t get above it (and there’ll be a notch)
dull to percuss (kidney is resonant bc of overlying bowel)

Question 16

clubbing DDx

Answer 16

1. CCF
2. chronic lung disease
3. gastro = IBD/coeliac/cirrhoses

Question 17

ascites - interpretation of SAAG

Answer 17

SAAG >1 = portal HTN/CCF i.e. increased hydrostatic pressure

SAAG <1 = decreased oncotic pressure e.g. PLE, nephrotic syndrome

Question 18

if PCK, what should you examine?

Answer 18

1. liver (for cysts)
2. 3rd nerve palsy (berry aneurysm)
3. MVP on auscultation
4. other kidney (should also be enlarged)

Question 19

portal HTN signs

Answer 19

1. splenomegaly
2. spider naevi
3. caput medusae
4. ascites/peripheral oedema

Question 20

DDx of portal hypertension

Answer 20

1. pre-hepatic - portal vein thrombosis
2. intra = cirrhosis
3. post-hepatic = pul HTN