Gastro Short Flashcards
Causes of gum hypertrophy?
Phenytoin Pregnancy Scurvy Gingivitis Leukaemia
Causes of pigmented lesions in the mouth?
Heavy metals Anti malarials OCP Addison's disease Peutz-Jegher Melanoma
Causes of mouth ulcers?
Trauma Drugs Crohn's/UC Coeliac disease Behcet's Herpes Syphilis
Causes of hepatomegaly?
Metastases Alcoholic liver disease with fatty infiltration Myeloproliferative disease Right heart failure Hepatocellular cancer Haemochromatosis Leukaemia/lymphoma Amyloid Hepatitis
Causes of hepatosplenomegaly?
Chronic liver disease with portal hypertension Haematological disease Infection Infiltration - amyloid, sarcoid Connective tissue disease Acromegaly Thyrotoxicosis
Signs of chronic liver disease in the hands?
leuconychia, clubbing, palmar erythema, brusing, asterixis
Signs of portal hypertension?
splenomegaly, collateral veins, ascites
Systemic signs of UC?
chronic liver disease anaemia arthritis erythema nodosum pyoderma gangrenosum clubbing conjunctivitis, iritis, episcleritis
Signs of malabsorption?
glossitis angular stomatitis bruising oedema peripheral neuropathy
Causes of ascites with a high albumin gradient (>11g/L)
Budd chiari cirrhosis heart failure alcoholic hepatitis portal vein thrombosis
Causes of ascites with a low albumin gradient (<11g/L)
malignancy pancreatitis infection nephrotic syndrome serositis
Causes of splenomegaly?
Massive (LMLM) - lymphoma - myelofibrosis - leukaemia - malaria Moderate (PLLTS) - portal HTN - leukaemia - lymphoma - thallasemia - storage (gaucher) Mild - myeloproliferative disorders - haemolytic anaemia - infection - EBV, HBV, - CTD - SLE/RA - infiltrate - amyloid, sarcoid
Causes of cirrhosis?
EtOH Viral (Hep C, B, D) NASH Drugs Autoimmune hepatitis Haemochromatosis Wilson's disease PSC PBC Alpha-1 antitrypsin deficiency Cardiac failure Cryptogenic
Sequelae of cirrhosis?
Portal hypertension (ascites, varices) Portal vein thrombosis SBP Hepatic encephalopathy Hepatorenal syndrome Hepatocellular carcinoma Osteoporosis Thrombocytopaenia Coagulopathy
Elements of Child Pugh score?
bilirubin albumin ascites encephalopathy INR
Extrahepatic manifestations of Hepatitis C?
cryoglobulinaemia porphyria cutanea tarda membranoproliferative GN lichen planus hashimoto's thyroiditis sjogren's diabetes polyarthritis lymphoproliferative disorders
Signs of haemochromatosis?
bronze pigmentation arthropathy (index and middle MCP) testicular atrophy dilated cardiomyopathy glycosuria
Reversible causes of hepatic encephalopathy?
alcohol drugs GI haemorrhage infection constipation
Differences between crohn’s and UC?
crohn’s has patchy distribution whereas UC is continuous
crohn’s is transmural whereas UC is superficial
crohn’s affects whole GI tract whereas UC affects large bowel
fistulae and stenosis are common in crohn’s but rare in UC
How do you differentiate splenomegaly from an enlarged kidney?
spleen: moves towards RIF on inspiration, unable to get above, dull to percussion, non ballotable, presence of a notch
kidney: can get above, resonant to percussion, ballotable
Investigations for splenomegaly?
FBE and blood film haemolysis screen LFTs UEC CRP blood cultures malaria screen virology for EBV RF BMAT lymph node biopsy CT C/A/P TTE if suspect IE
What advice should be given to patients undergoing splenectomy?
preoperative vaccination: pneumococcal, meningococcal, haemophillus influenzae lifelong prophylactic penicillin annual influenza vaccination wear medic alert bracelet seek medical attention if unwell
Indications for splenectomy?
ITP mass effect of spleen traumatic rupture haematological malignancies congenital haemolytic anaemia
Signs of alcohol misuse?
cachexia tremor parotid enlargement dupuytren's contracture cerebellar syndrome peripheral neuropathy
What is the inheritance of haemochromatosis?
autosomal recessive
Causes of a right upper quadrant mass?
liver
kidney
gallblader
colon
Causes of a left upper quadrant mass?
spleen left kidney colon pancreas stomach
Causes of a right lower quadrant mass?
colon
pelvic mass
Causes of a left lower quadrant mass?
colon
pelvic mass
