Gastro Osce

Question 1

A smooth enlarged liver would be indicative of _____

Answer 1

Venous congestion, Fatty infiltration

Question 2

A Knobbly liver edge would be indicative of ______

Answer 2

Metastasis / Cysts

Question 3

A pulsatile liver is associated with _________

Answer 3

TR

Question 4

A tender liver would be indicative of ________

Answer 4

Hepatitis, RHF (capsular pain)

Question 5

A bruit of the liver would indicate __________

Answer 5

Hepatocellular carcinoma , AV malformation

Question 6

Multifactorial aetiology of ascites

Answer 6

1) Portal hypertension
2) Hypoalbuminaemia
3) Salt and water retention (RAAS activation)

Question 7

Causes of gynaecomastia

Answer 7

1) Physiological (puberty and elderly)

2) Testicular failure
- Klinefelters syndrome
- Viral orchitis / Testicular trauma
- Haemodialysis

3) Increase oestrogen
- Chronic liver disease
- Thyrotoxicosis
- Oestrogen secreting tumour

4) Drug induced (DISCO MTV)
- Digoxin
- Isoniazid
- Spironolactone
- Cimetidine and Calcium channel blockers
- Oestrogen
- Methyldopa
- Tricyclics
- Verapamil

Question 8

What are the main causes of hepatosplenomegaly

Answer 8

Infection
   - Hepatitis
   - EBV
   - Malaria
Haematological
   - Lymphoma
   - Leukaemia
   - Myelofibrosis
   - Haemolytic anaemia
Infiltrative
   - Sarcoid and amyloid

Question 9

Extra-intestinal manifestations of IBS

Answer 9

• Finger clubbing
• Mouth ulcers
• Eyes
  
  • episcleritis
  • conjunctivitis
• Skin
  
  • erythema nodosum
  • Pyoderma gangrenosum
• Joints
  
  • Seronegative Spondyloarthropathy
• PSC (especially Ulcerative colitis)
• Amylodosis (especially Crohn’s)

Question 10

What are the causes of transudate ascities

Answer 10

Transudate (Protein < 30g/L)

• CLD
• CCF
• Volume overload
• Hypoalbuminaemia
• Constrictive pericarditis

Question 11

What are the causes of Exudate ascites

Answer 11

Exudate (Protein >30g/L)

• Infection - TB, Pyogenic infection
• Inflammation -Pancreatitis
• Malignancy - luminal, Pancrease, Liver, Ovarian, Lymphoma

Question 12

Infectious causes of hepatomegaly?

Answer 12

Infection

• hepatits
• EBV
• Malaria
• Liver abscess

Question 13

Neoplastic causes of hepatomegaly?

Answer 13

Neoplastic

• Primary
• Metastatic

Question 14

Congestive causes of hepatomegaly?

Answer 14

• RHF
  
  • Tricuspid regurgitation
  • Budd-Chiari syndrome

Question 15

Haematological causes of Hepatomegaly

Answer 15

Haematological

• Lymphoma / Leukaemia
• Myelofibrosis
• Sickle cell and haemolytic anaemia

Question 16

Infiltrative causes of hepatomegaly

Answer 16

Infiltrative

• Sarcoid / Amyloid
• Haemochromatosis
• Fatty liver

Question 17

Billiary causes of hepatomegaly

Answer 17

Billiary

• Primary billiary sclerosis
• Primary sclerosing cholangitis

Question 18

Causes of a massive splenomegaly (past umbilicus)

Answer 18

Massive (MM) - past umbilicus

• Malaria
• Myeloproliferative (myelofibrosis, CML)

Question 19

Causes of moderate splenomagaly (up to umbilicus)

Answer 19

Moderate - up to umbilicus

• Lymphoma / Leukaemia
• Portal Hypertension
• Haemolytic anaemia

Question 20

Causes of a mild splenomegaly

Answer 20

Mild - Hard to grip

• Glandular fever
• RA (felty’s syndrome)
• Infective endocarditis
• Pernicious anaemia