Gastro, liver and renal Flashcards
On general inspection in abdo examination what do you look for?
- Jaundice
- Pallor
On inspection of hands in abdo examination what should you look for?
- Asterixis (liver flap)
- Bruising
- Clubbing
- Dupuytren’s contracture
- Erythema (palmar)
- Leukonychia (Hypoalbuminuria)
On inspection of forearms in abdo examination what do you look for and what could this be a sign of?
- AV fistulae
- This could be a sign of current or previous renal replacement therapy
on examination of head and neck of an abdo exam what do you look at?
- Anaemia and jaundice
- Look at skin for jaundice, excoriation marks or spider naevi
- Oral examination look at pigment in mouth and for gum hypertrophy
- Fecal hepaticus may also be present due to presence of ketones and ammonia
What could gum hypertrophy suggest in context of an abdo examination?
The patient is on ciclosporine after renal transplant
on inspection of chest in abdo examination what should you look for?
- Gynaecomastia
- Hair loss
- Excoriation marks
- Spider naevi
When insepcting abdomen what should you look for?
- Abdominal distention
- Caput medusae (swollen veins in abdomen that appear around abdomen)
- Scars
What are caput medusae?
-Distended superficial abdominal veins, you can put a finger to look at direction of flow
State 4 causes for hepatomegaly
- Cancer (primary or secondary deposits)
- Cirrhosis (early, usually alcoholic)
- Cardiac (congestive heart failure or constrictive pericarditis)
- Infiltration (fatty infiltration, haemochromatosis, amyloidosis, scarcoidosis, lymphoproliferative diseases)
Summarise the cause of liver diseases
- Alcohol
- Autoimmune
- Drugs
- Viral
- Biliary disease
What are the two broad causes of splenomegaly?
Hepatology or haematology
What are the four causes of splenomegaly?
- Hepatology (portal hypertension) if present must go to A and E
- Haematological (e.g. lymphoma)
- Infection (e.g. EBV virus)
- Inflammation
What are the main presentations/findings with abdominal pain?
- Abdominal pain
- Abdominal distension
- Change of bowel habit
- GI bleed
- Jaundice
- Ascites
What are the main conditions?
- Peptic ulcer
- Pancreatitis
- Pancreatic cancer
- Cholecystitis
- Hepatitis
- Chronic liver disease
- Appendicitis
- Diverticulitis
- Ruptured aortic aneurysm
- IBD
- Coeliac
If a patient has ruptured aortic aneurysm how would they present?
-Epigastric, back and flank pain
-Haemodynamically compromised (hypotension)
-Loss of consciousness
-Pallor
-Abdominal distention
fever
What are the two main “natures” of abdominal pain?
- Constant (normally caused by inflammation)
- Colickly (normally caused by obstruction)
What is abdominal pain that is constant in nature usually caused by?
Inflammation
What is abdominal pain that is colicky in nature usually caused by?
obstruction
What are the two main organs associated with epigastric pain?
Stomach and prancreas
What could be the DDx for stomach related epigastric pain?
Peptic ulcer - ask about NSAID
GORD - better with antacids
Gastritis - retrosternal pain alcohol
Malignancy
What could be the DDx for pancreas related epigastric pain ?
Acute pancreatitis - look at history do they have a history of gallstones, is amylase high
What could pain above epigastric region be caused by?
MI
What could pain below epigastric region be caused by?
Ruptured aortic aneurysm
What could pain to the right of epigastric region be caused by?
Cholecystitis
Hepatitis
What could pain to the left of epigastric region be caused by?
Spleen (less common)
What is the difference in amylase with acute vs chronic pancreatitis?
In acute pancreatitis their is high amylase and in chronic pancreatitis amylase is normal
What are the pain symptoms of acute pancreatitis?
- sudden onset mid-epigastric pain (LUQ) which can radiate to the back
- nausea and vomiting
What is the are the most common causes of acute pancreatitis?
Gallstones and excessive alcohol consumption
What is the initial treatment for acute pancreatitis?
Initial treatment focuses on resuscitation with intravenous fluids, analgesia, and nutritional support, with early oral feeding favoured if tolerated.
What are the most common symptoms of chronic pancreatitis?
Epigastric abdominal pain radiating to the back, steatorrhoea, malnutrition, weight loss and diabetes mellitus
What happens to endocrine and exocrine function in chronic pancreatitis?
Loss of endocrine and exocrine function
What investigation can be used to see if there is pancreatic insufficiency?
Fecal elastase
What are the two main organs associated with RUQ pain?
The gall bladder and liver
What is cholangitis?
Inflammation of bile duct system - accompanied with charcoits triad and normally caused by biliary tree obstruction
What is cholecystitis?
Acute gallbladder inflammation - normally caused by complete cystic duct obstruction which leads to gallbladder inflammation
What could cause RUQ pain caused by the gall bladder?
Cholecystitis
Cholangitis
Gall stones
What could cause RUQ pain caused by the liver?
Hepatitis
Abscess
What could pain above RUQ be caused by?
Basal pneumonia
What could pain below the RUQ be caused by?
Appendicitis
