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awesomesauce fracp > Gastro and Haem > Flashcards

Gastro and Haem Flashcards

1
Q

Causes of hepatomegaly

A

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.

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2
Q

Causes of a firm and irregular liver

A

Cirrhosis
Metastatic disease
Hydatid disease, granuloma, amyloid, cysts, lipoidoses

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3
Q

Causes of a tender liver

A

Hepatitis
Rapid liver enlargement- RHF, Budd-Chiari syndrome
HCC

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4
Q

Causes of a pulsatile liver

A

TR
HCC
Vascular abnormalities

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5
Q

Causes of renal masses: bilateral

A

PCKD
Hydronephrosis or pyonephrosis (bilateral)
Hypernephroma (bilateral renal cell carcinoma)
Acute renal vein thrombosis (bilateral)
Amyloid, lymphoma and other infiltrative diseases
Acromegaly

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6
Q

Causes of renal masses: unilateral

A 
Renal cell carcinoma
Hydronephrosis or pyonephrosis
Polycystic kidney (asymmetrical enlargement)
Acute renal vein thrombosis
Normal right kidney or a solitary kidney
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7
Q

Approach to patient with PCKD

A
  1. Take BP (75% have hypertension)
  2. Examine urine for haematuria (haemorrhage into a cyst) and proteinuria (usually <2g/day)
  3. Looks for anaemia (from CKD) or polycythemia (due to high EPO). Hb usually higher than expected for degree of renal failure
  4. Note the presence of hepatic cysts (present in 30% of cases) and splenic cysts (rare).
    Subarachnoid haemorrhage occurs in 3% of pts
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8
Q

Causes of abdominal masses: right iliac fossa

A 
Appendiceal abscess
Carcinoma of the caecum
Crohn's disease
Pelvic kidney
Ovarian tumour or cyst
Carcinoid tumour
Amoebiasis
Psoas abscess
Illeocaecal TB
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9
Q

Causes of abdominal masses: left iliac fossa

A 
Faeces
Carcinoma of sigmoid or descending colong
Diverticular disease
Ovarian tumour or cyst
Psoas abscess
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10
Q

Causes of abdominal masses: upper abdomen

A 
Retroperitoneal lymphadenopathy (e.g. lymphoma, teratoma. 
Abdominal aortic aneurysm (pulsatile)
Carcinoma of stomach
Pancreatic pseudocyst or tumour
Pyloric stenosis
Carcinoma of transverse colon
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11
Q

Causes of splenomegaly

A

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)
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12
Q

Causes of hepatosplenomegaly

A

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

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13
Q

Signs of haemachromatosis

A

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)

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14
Q

Causes of generalised lymphadenopathy

A

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)

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15
Q

Causes of parotid enlargement

A

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

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16
Q

Causes of gum hypertrophy

A 
Phenytoin
Pregnancy
Vitamin C deficiency (gums spongy, red, bleed easily)
Gingivitis
Leukaemia
17
Q

Classification of ascites

A

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

18
Q

Liver disease: CFx

A

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.

19
Q

CLD: causes

A 
Alcohol
NAFLD
Hepatitis B/C
PBC
PSC
20
Q

Portal hypertension: CFx

A

Splenomegally
Collateral veins (on abdomen or haematemesis)
Ascites

21
Q

Portal hypertension: causes

A
  1. Cirrhosis
  2. 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
22
Q

Hepatic encephalopathy: grading

A 
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
23
Q

Causes of decompensation of CLD

A
  • 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
24
Q

Inflammatory bowel disease: CFx

A

PERIPHERY: peripheral non-deforming arthropathy affecting the knees/ankles/wrist, ankylosing spondylitis, erythema nodosum, anaemia, finger clubbing
EYES: conjunctivitis, iritis, episcleritis

25
Q

Causes of cirrhosis

A
  • Alcohol
  • postviral hep B or C
  • NASH
  • drugs (methyldopa, chlorpromazine, isoniazid, niteofurantonin, PTU, MTX, amiodarone)
  • autoimmune
  • haemacheomatosis
  • Wilson’s disease
  • PSC
  • PBC
  • alpha 1 antitrypsin deficiency
  • cystic fibrosis
  • budd chiara syndrome
  • cardiac failure
  • idiopathic

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