Gastro and Haem Flashcards
Causes of hepatomegaly
MASSIVE: metastases, alcoholic liver disease with fatty infiltration, myeloproliferative disease, RHF, HCC.
MODERATE: above + haemochromatosis, haematological disease (CML, lymphoma), fatty liver (obesity, DM, toxins).
MILD: above + hepatitis (viral, drugs), cirrhosis, biliary obstruction, granulomatous disorders, hydatid disease, amyloidosis and other infiltrative diseases, HIV infection, ischaemia.
Causes of a firm and irregular liver
Cirrhosis
Metastatic disease
Hydatid disease, granuloma, amyloid, cysts, lipoidoses
Causes of a tender liver
Hepatitis
Rapid liver enlargement- RHF, Budd-Chiari syndrome
HCC
Causes of a pulsatile liver
TR
HCC
Vascular abnormalities
Causes of renal masses: bilateral
PCKD
Hydronephrosis or pyonephrosis (bilateral)
Hypernephroma (bilateral renal cell carcinoma)
Acute renal vein thrombosis (bilateral)
Amyloid, lymphoma and other infiltrative diseases
Acromegaly
Causes of renal masses: unilateral
Renal cell carcinoma Hydronephrosis or pyonephrosis Polycystic kidney (asymmetrical enlargement) Acute renal vein thrombosis Normal right kidney or a solitary kidney
Approach to patient with PCKD
- Take BP (75% have hypertension)
- Examine urine for haematuria (haemorrhage into a cyst) and proteinuria (usually <2g/day)
- Looks for anaemia (from CKD) or polycythemia (due to high EPO). Hb usually higher than expected for degree of renal failure
- Note the presence of hepatic cysts (present in 30% of cases) and splenic cysts (rare).
Subarachnoid haemorrhage occurs in 3% of pts
Causes of abdominal masses: right iliac fossa
Appendiceal abscess Carcinoma of the caecum Crohn's disease Pelvic kidney Ovarian tumour or cyst Carcinoid tumour Amoebiasis Psoas abscess Illeocaecal TB
Causes of abdominal masses: left iliac fossa
Faeces Carcinoma of sigmoid or descending colong Diverticular disease Ovarian tumour or cyst Psoas abscess
Causes of abdominal masses: upper abdomen
Retroperitoneal lymphadenopathy (e.g. lymphoma, teratoma. Abdominal aortic aneurysm (pulsatile) Carcinoma of stomach Pancreatic pseudocyst or tumour Pyloric stenosis Carcinoma of transverse colon
Causes of splenomegaly
MASSIVE: CML, myelofibrosis, primary lymphoma of spleen, hairy cell leukaemia, malaria, kala-azar.
MODERATE: above + portal hypertension, lymphoma, leukaemia (chronic or acute), thalassaemia, storage diseases (e.g. Gaucher’s disease).
SMALL: above + other myeloproliferative disorder (polycythemia rubra vera, ET), haemolytic anaemia, megaloblastic anaemia (rarely), infection (EBV, hepatitis, bacterial / IE), CTD (RA, SLE, polyarteritis nodosa), infiltration (amyloidosis, sarcoidosis)
# Haem: - myeloproliferative disease (PCRV, myleofibrosis) - malignant (CML, AML, lymphoma) - haemolytic anaemia # Infective (EBV, CMV, hepatitis) # CTD (RA, SLE) # infiltration (sarcoidosis)
Causes of hepatosplenomegaly
Chronic liver disease with portal HT
Haematological (myeloproliferative disease, lymphoma, leukaemia, pernicious anaemia, sickle cell anaemia)
Infection (acute viral hepatitis, glandular fever, CMV)
Infiltration (amyloidosis, sarcoidosis)
CTD (SLE)
Acromegaly
Thyrotoxicosis
Signs of haemachromatosis
Pigmentation (bronze)
Arthropathy (degenerative arthritis of the MCP joints of the index and middle fingers)
Testicular atrophy (iron deposition in the pituitary gland)
Dilated cardiomyopathy
Glycosuria (due to DM)
Causes of generalised lymphadenopathy
Lymphoma (rubbery and firm)
Leukaemia (CLL, ALL)
Malignant disease (metastases or reacitve changes usually causing asymmetrical, very firm nodules)
Infections: viral (CMV, HIV, EBV), bacterial (TB, brucellosis), protozoal (toxoplasmosis)
CTD (RA, SLE)
Infiltrations (sarcoidosis)
Drugs (phenytoin)
Causes of parotid enlargement
BILATERAL: mumps, sarcoidosis, lymphoma, Mikulicz syndrome (bilateral painless enlargement, thought to be early Sjogren’s), alcohol associated parotitis, malnutrition, severe dehydration.
UNILATERAL: mixed parotid tumour, tumour infiltration (may cause facial nerve palsy), duct blockage
Causes of gum hypertrophy
Phenytoin Pregnancy Vitamin C deficiency (gums spongy, red, bleed easily) Gingivitis Leukaemia
Classification of ascites
SAAG >1.1g/dL
Cirrhosis, alcoholic hepatitis, CCF, constrictive pericarditis, Budd-Chiari syndrome or veno-occlusive disease, myxoedema, massive liver mets.
SAAG <1.1g/dL
Peritoneal carcinomatosis, TB, pancreatic ascites, nephrotic syndrome
Liver disease: CFx
HANDS: leuconychia, clubbing, palmar erythema, bruising, asterixis
FACE: jaundice, scratch marks, spider naevi, bruising, pectoral muscle wasting
CHEST: gynaecomastia, loss of body hair, bruising
ABDO: hepatosplenomegally, signs of portal hypertension, testicular atrophy
LEGS: oedema, muscle wasting, bruising
Two or more suggest cirrhosis: spider naevi, palmar erythema, splenomegaly, ascites, abnormal veins on abdomen.
CLD: causes
Alcohol NAFLD Hepatitis B/C PBC PSC
Portal hypertension: CFx
Splenomegally
Collateral veins (on abdomen or haematemesis)
Ascites
Portal hypertension: causes
- Cirrhosis
- Other
- Presinusoidal: portal vein compression (e.g. lymphoma, carcinoma), intravascular clotting (e.g. polycythemia), umbilical vein phlebitis
- Intrahepatic: sarcoid, lymphoma or leukaemic infiltrates, congenital hepatic fibrosis
- Postsinusoidal: hepatic vein outflow obstruction (budd chiari: idiopathic, myleloproliferative disease, tumour, PNH, OCP), veno-occlusive disease, constrictive pericarditis, CCF
Hepatic encephalopathy: grading
0 = normal mental state 1 = mental changes (lack of awareness, anxiety, euphoria, reduced attention span, impaired ability to add and subtract) 2 = lethargy, disorientation, personality changes, inappropriate behaviour 3 = stupor, but responsive to stimuli, gross disorientation, confusion 4 = coma
Causes of decompensation of CLD
- GI bleeding (increases nitrogenous contents in the bowel)
- Infection (UTI, SBP, chest infection)
- Acute liver cell decompensation (e.g. alcohol binge or hepatoma)
- Metabolic disturbances (hypoglycaemia, hypokalaemia)
- Sedatives
Inflammatory bowel disease: CFx
PERIPHERY: peripheral non-deforming arthropathy affecting the knees/ankles/wrist, ankylosing spondylitis, erythema nodosum, anaemia, finger clubbing
EYES: conjunctivitis, iritis, episcleritis
