Gastro Shorts

Question 1

Things to inspect on the abdomen

Answer 1

Scars, distension, masses, organomegaly, prominent veins, striae, bruising, pigmentation

Question 2

Causes of massive hepatomegaly

Answer 2

1. Metastases
2. Alcoholic liver disease with fatty infiltration
3. Myeloproliferative disease
4. Right heart failure
5. Hepatocellular carcinoma

Question 3

Causes of moderate hepatomegaly

Answer 3

Same as massive

2. Haemochromatosis
3. Haematological disease - CML, lymphoma
4. Fatty liver - obesity, DM, toxins

Question 4

Causes of mild hepatomegaly

Answer 4

Same as massive/moderate

2. Hepatitis (viral, drugs)
3. Cirrhosis
4. Biliary obstruction
5. Granulomatous disorders
6. Hydatid disease
7. Amyloidosis
8. HIV
9. Ischaemia

Question 5

Causes of firm and irregular liver

Answer 5

1. Cirrhosis
2. Mets
3. Hydatid disease, granuloma, amyloid, cysts, lipoidoses

Question 6

Causes of tender liver

Answer 6

1. Hepatitis
2. Rapid enlargement - R heart failure, Budd Chiari
3. Hepatocellular carcinoma

Question 7

Causes of pulsatile liver

Answer 7

1. TR
2. HCC
3. Vascular abnormalities

Question 8

Causes of bilateral renal masses

Answer 8

1. PCKD
2. Bilateral hydro or pyonephrosis
3. Bilateral RCC
4. Bilateral acute renal vein thrombosis
5. Amyloid, lymphoma, other infiltrative diseases
6. Acromegaly

Question 9

Causes of unilateral renal mass:

Answer 9

1. RCC
2. Hydro/pyonephrosis
3. PCKD (asymmetrical)
4. Acute renal vein thrombosis
5. Normal right kidney or solitary kidney

Question 10

Causes of massive splenomegaly

Answer 10

1. CML
2. Myelofibrosis
3. Primary splenic lymphoma, hairy cell leukaemia, malaria, kala-azar

Question 11

Causes of moderate splenomegaly

Answer 11

Same as massive

2. Portal HTN
3. Lymphoma
4. Leukaemia (chronic or acute)
5. Thalassaemia
6. Storage diseases (Gaucher’s disease)

Question 12

Causes of mild splenomegaly

Answer 12

Same as moderate/massive

2. Other MPNs
3. Haemolytic anaemia
4. Megaloblastic anaemia
5. Infection - viral (mono, hepatitis), bacterial endocarditis
6. CTS/vasculitis- RA, SLE, PAN
7. Infiltration - amyloid, sarcoid

Question 13

Causes of hepatosplenomegaly

Answer 13

1. Chronic liver disease with portal HTN
2. Haematological disease - MPNs, lymphoma, leukaemia, pernicious anaemia, sickle cell anaemia
3. Infection - acute viral hepatitis, glandular fever, CMV
4. Infiltration - amyloidosis, sarcoidosis
5. CTD - SLE
6. Acromegaly
7. Thyrotoxicosis

Question 14

How to tell kidney vs spleen:

Answer 14

1. Spleen no palpable upper border
2. Spleen has a notch
3. Spleen moves inferomedially on inspiration
4. No resonance over a splenic mass
5. Spleen not bimanually palpable (not ballottable)
6. Friction rub may occasionally be heard over spleen

Question 15

Things to inspect on the hands

Answer 15

Nails - clubbing, leukonychia
Palmar erythema
Dupuytren's
Arthropathy
Hepatic flap

Question 16

Things to inspect on the arms

Answer 16

Spider naevi
Bruising
Wasting
Scratch marks

Question 17

Things to inspect in the face

Answer 17

Eyes - jaundice, anaemia, iritis, Kayser-Fleischer rings
Parotids
Mouth- fetor hepaticus
Lips- stomatitis, leukoplakia, ulceration, localised pigmentation (Peutz-Jeghers syndrome), telangectasis (HHT)
Gums- gingivitis, bleeding, hypertrophy, pigmentation, Candida
Tongue- atrophic glossitis, leukoplakia, ulceration