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Clinical Examination > Gastrointestinal examination > Flashcards

Gastrointestinal examination Flashcards

1
Q

What are causes of chronic liver disease?

A
  1. Alcohol
  2. Viral hepatitis
  3. Fatty liver
  4. Wilson’s disease
  5. Haemachromatosis
  6. PBC
  7. PSC
  8. Autoimmune hepatitis
  9. Drugs
  10. a-1 antitrypsin deficiency
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2
Q

What are signs of aetiology of cirrhosis?

A

Hepatitis - race, tattoos, IVDU
Alcohol - parotidmegaly, dupuytren’s testicular atrophy, cerebellar signs, peripheral neuropathy
Haemachromatosis - pigmentation, 2nd, 3rd MCP arthritis, T2DM, anglo
Wilson’s - kayser-fleischer rings
Fatty liver - xanthelasma, xanthoma, obesity, loose skin folds

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3
Q

What are 5 signs of decompensated liver disease?

A
  1. Jaundice
  2. Encephalopathy - mentition, asterixis
  3. Portal hypertension - ascites, splenomegaly, caput medusa
  4. bruising
  5. loss of muscle bulk
    (foetor hepaticus)
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4
Q

What are causes of decompensated liver disease?

A
  1. Infection - SBP, UTI, asp Pneumonia
  2. HCC
  3. Portal vein thrombosis
  4. EtOH binge
  5. Dehydration - diuretics, diarrhoea, vomiting
  6. Protein load - GI bleed
  7. Metabolic disturbance - hypoglycaemia
  8. Drugs - sedatives, diuretics
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5
Q

What are complications of cirrhosis?

A 
Portal hypertension (varices, hypersplenism)
HCC
Coagulopathy
Osteoporosis
Hepatopulmonary syndrome
Poor nutrition
Impotence
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6
Q

What are causes of massive hepatomegaly?

A 
metastases
hepatocellular carcinoma
myeloproliferative dis
alcoholic liver dz with fatty infiltration
RH failure
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7
Q

What are causes of moderate hepatomegaly?

A

haematological disease - CML, lymphoma
Fattly liver - obesity, DM, toxins
Metabolic/infiltrative - haemachromatosis, wilson’s disease

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8
Q

What are causes of mild hepatomegaly?

A 
hepatitis
cirrhosis
biliary obstruction
infiltrative - granulomatous disorders (sarcoid, amyloid)
hydatid disease
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9
Q

What are malignant causes of hepatomegaly?

A

metastases
HCC
myeloproliferative
lymphoproliferative

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10
Q

What are fatty infiltrative causes of hepatomegaly?

A

alcoholic liver dz w fatty infiltration
obesity
DM
steroids

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11
Q

What are infectious causes of hepatomegaly?

A

hepatitis

hydatid disease

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12
Q

What are infiltrative and metabolic causes of hepatomegaly?

A 
sarcoidodis
amyloidosis
haemachromatosis
wilson's disease
cysts of PCKD
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13
Q

What are obstructive causes of hepatomegaly?

A

right heart failure
budd chiari
biliary tract obstruction

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14
Q

What are causes of hepatosplenomegaly?

A 
cirrhosis with portal hypertension
myelofibrosis
PCV
essential thrombocytosis
CML
Hodkin's lymphoma
Indolent lymphomas (e.g. CLL)
Thalassaemia
spherocytosis
Viral (EBV)
Endocarditis
Parasitic (malaria)
amyoid
sarcoid
SLE/RA/PAN
Acromegaly
Thyrotoxicosis
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15
Q

What are causes of a firm and irregular liver?

A

Cirrhosis
Metastatic disease
Hydatid disease, granuloma, amyloid, cysts, lipoidoses

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16
Q

What are causes of a tender liver?

A

Hepatitis
Rapidly enlarging liver - RHF, Budd chiari
HCC

17
Q

What are causes of a pulsatile liver?

A

Tricuspid regurgitation
HCC
Vascular abnormalities

18
Q

What are causes of bilateral renal masses?

A 
PCKD
Hydronephrosis/pyonephrosis
Hypernephroma (bilat RCC)
Acute renal vein thrombosis (bilat)
Amyloid, lymphoma, other infilt
Acromegaly
19
Q

What are causes of unilateral renal masses?

A 
RCC
Hydronephrosis or pyonephrosis
PCKD (asymmetric)
Acute renal vein thrombosis
Normal right kidney, or solitary kidney (uncommon)
20
Q

What are findings on general inspection in PKD?

A

sallow complexion
AVF or subclavian catheter
Hyperventilation (Acidosis), malnutrition
Scars or skin cancers if renal transplant present

21
Q

What are features on abdominal examination in PKD?

A

Inspection - scars, tenkhoff, excoriation
Palpations - palpable kidneys, palpable liver (cysts)
Abdominal wall/inguinal hernia
Transplanted kidney
NO SPLENOMEGALY

22
Q

What are features of palpable kidneys?

A
  1. can feel upper pole/get above
  2. ballotable
  3. moves inferiorally on inspiration
  4. resonant percussion note if bowel overlying
  5. no notch
  6. no friction rub
23
Q

What are features on hand/arm exam in PKD?

A

nail changes - distal brown arc
anaemia
uraemic flap
hypertension

24
Q

What are features on neck exam in PKD?

A

elevated JVP

parathyroidectomy scars

25
Q

What are features on CV examination in PKD?

A

mitral valve prolapse in 25%, AR and TR also increased

Pericarditis - uraemic

26
Q

What are findings on examination of the LL in PKD?

A

peripheral oedema, peripheral neuropathy, gout

27
Q

What are other findings in PKD?

A

urinalysis for haematuria
fundoscopy (HTN changes)
ECG for LVH evidence

28
Q

What are associations with PCKD?

A 
Berry aneurysms
Cardiac valve - MVP, MR, TR, AR
Cysts in other organs (liver, pancreas, lungs, thyroid, CNS)
Diverticular disease
Dipstick for haematuria, proteinuria
End stage renal failure
29
Q

What are SEs in transplant patients receiving steroids?

A 
Osteoporosis
Proximal myopathy
cataracts
Diabetes
Cushings
Hypogonadism
Infections
30
Q

What are causes of RIF masses?

A 
Appendiceal abscess
Caecal carcinoma
Crohn's disease
Pelvic kidney
Ovarian tumour/cyt
Carcinoid tumour
Amoebiasis
Psoas abscess
Ileocaecal tuberculosis
31
Q

What are causes of LIF masses?

A 
Faeces (can be indented)
Carcinoma of sigmoid/descending colon
Diverticular disease
Ovarian tumour/cyst
Psoas abscess
32
Q

What are causes of upper abdominal masses?

A 
Retroperitoneal LA
Abdominal aortic aneurysm
Carcinoma of stomach
Pancreatic pseudocyst/tumour
Pyloric stenosis
Carcinoma of t'verse colon
33
Q

What are causes of massive splenomegaly?

A

CML
myelofibrosis
primary lymphoma of spleen, hairy cell leukaemia, malaria, kala-azar (all rare)

34
Q

What are causes of moderate splenomegaly?

A 
as for massive +
portal hypertension
lymphoma
leukaemia (chronic/acute)
thalassaemia
storage diseases (gaucher's disease)
35
Q

What are causes of small splenomegaly?

A 
As per moderate and large +
PCV, ET
haemolytic anaemia
megaloblastic anaemia (rare)
infection - EBV, hepatitis, IE
CTD/Vasculitis - RA, SLE, PAN
Infiltration - amyloidosis, sarcoidosis

Clinical Examination (3 decks)

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