Gastroenterology Flashcards
Causes of hepatomegaly
Massive?
Chronic liver disease (NAFLD, alcohol, viral) with fatty infiltration/hepatoma
Vascular - congestion due to TR (pulsatile)
Toxins - haemochromatosis
Neoplastic- Liver mets/HCC
+ haem* - Myelofibrosis, myelodysplasia, lymphoma, CML
Massive - myelofibrosis/dysplasia, HCC/mets, fatty infiltration, TR
*haem usually assoc. with splenomegaly
Causes of splenomegaly
which are usually massive?
Haem: myelofibrosis, CML, myelodysplasia, lymphoma, CLL, PRV
Hepatic: portal HTN
Infective: CMV/EBV (usually assoc. hepatomegaly)
CTD: RA, sarcoid
MASSIVE = 3 Ms - Myelofibrosis, CML, Myelodysplasia
Causes of moderate splenomgaly
Lymphoma
CLL
PRV
Portal HTN
Causes of mild splenomegaly
Haem - PRV, ET, haemolytic anemia, ITP
CTD - sarcoid, amyloid
Gastro - Portal HTN
Causes of hepatosplenomeglay
Chronic liver disease with portal HTN
Haem - Myelofibrosis, myelodysplasia, lymphoma, leukemia, anemias (pernicious anemia, sickle cell)
Infection - hepatitis (acute), glandular fever/CMV
CTD - SLE
Infiltrative - sarcoid, amyloid
Endo - acromegaly, thyrotoxicosis
Indicators of decompensation in CLD
Ascites Encephalopathy SBP HCC HRS HPS Variceal bleeding
Signs of haemochromatosis
Moderate hepatomegaly Bronzed pigementation Arthropathy (MCP joints, index + middle finger most common) Testicular atrophy Dilated cardiomyopathy
+ glucosuria
Causes of tender hepatomegaly
Hepatitis
HCC
Rapid enlargement of liver –> Budd-chiari, Right heart failure
Extra intestinal manifestations of Inflammatory Bowel Disease
Derm:
- oral ulcers
- erythema nodosum
- pyoderma gangrenosum
Ocular:
- episcleritis
- uveitis
MSK:
- arthritis (large joint, ank spond)
Haem:
- VTE
Other GI:
- PSC
- renal calculi
Extra intestinal manifestations of IBD associated with active disease
Oral ulcers Erythema Nodosum Large joint arthritis (NOT ank spond) Episcleritis VTE
Differentials for bilateral ballotable kidneys
Bilateral renal cysts Bilateral hydronephrosis Amyloidosis Bilateral renal cell carcinoma and metastases Tuberous sclerosis PCKD
Differentials for a hepatic bruit
Alcohol hepatitis Hepatic carcinoma Hepatic AV malformation Hepatic hemangioma TIPS
Stigmata of chronic liver disease
Abdo - ascites, Caput madusae Skin - Jaundice, Spider naevi Hands - Palmar erythema, Clubbing Chest - Gynecomastia Mental stae - Encephalopathy
Extra-intestinal manifestations of PCKD
Cerebral anurysms
Cardiac valvular disease - MVP, AR
Extra renal cysts - liver, spleen, pancreas
How do you differentiate between a kidney and a spleen?
- Can’t get above spleen
- Can’t ballots spleen
- Spleen = dullness to percussion
- spleen moves inferiority and medially, kidney moves inferiority only
Signs of portal hypertension
Caput medusae
Splenomegaly
Ascites
Hepatic venous hum (heard over epigastrium)
How do you calculate SAAG and what does it mean?
Serum albumin - ascitic albumin
Elevated ≥1.1g/dL = portal HTN (cirrhosis, heart failure)
Causes of gum hypertrophy
Scurvy
AML
Cyclosporin
Causes of lower limb ulcers (other than DM)
Vasculitis
Hemoglobininopathies (Sickle cell, Spherocytosis , Thalassemia)
Waldenstroms Macroglobulinemia
Feltys
Causes of generalized lymphadenopathy
Infections (CMV, HIV, mono, bacterial, protozoal)
Toxins - Phenytoin (pseudolymphoma)
Autoimmune/rheum - CTD (RA, SLE)
Infiltration (sarcoid)
Malignancy , Lymphoma, Leukemia (CLL, ALL)
Cause of enlarged epitrochlear node
NHL
CLL
IVDU
Sarcoid
Causes of jaundice
Pre-hepatic:
Malaria
Sickle cell anemia
Hemolysis
Intrahepatic:
Hepatitis (viral, autoimmune)
Acute alcoholic hepatitis
HCC
Post-hepatic:
Cholelithiasis
Cholangiocarcinoma
Pancreatic cancer
