Gastrointestinal examination Flashcards
What are causes of chronic liver disease?
- Alcohol
- Viral hepatitis
- Fatty liver
- Wilson’s disease
- Haemachromatosis
- PBC
- PSC
- Autoimmune hepatitis
- Drugs
- a-1 antitrypsin deficiency
What are signs of aetiology of cirrhosis?
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
What are 5 signs of decompensated liver disease?
- Jaundice
- Encephalopathy - mentition, asterixis
- Portal hypertension - ascites, splenomegaly, caput medusa
- bruising
- loss of muscle bulk
(foetor hepaticus)
What are causes of decompensated liver disease?
- Infection - SBP, UTI, asp Pneumonia
- HCC
- Portal vein thrombosis
- EtOH binge
- Dehydration - diuretics, diarrhoea, vomiting
- Protein load - GI bleed
- Metabolic disturbance - hypoglycaemia
- Drugs - sedatives, diuretics
What are complications of cirrhosis?
Portal hypertension (varices, hypersplenism) HCC Coagulopathy Osteoporosis Hepatopulmonary syndrome Poor nutrition Impotence
What are causes of massive hepatomegaly?
metastases hepatocellular carcinoma myeloproliferative dis alcoholic liver dz with fatty infiltration RH failure
What are causes of moderate hepatomegaly?
haematological disease - CML, lymphoma
Fattly liver - obesity, DM, toxins
Metabolic/infiltrative - haemachromatosis, wilson’s disease
What are causes of mild hepatomegaly?
hepatitis cirrhosis biliary obstruction infiltrative - granulomatous disorders (sarcoid, amyloid) hydatid disease
What are malignant causes of hepatomegaly?
metastases
HCC
myeloproliferative
lymphoproliferative
What are fatty infiltrative causes of hepatomegaly?
alcoholic liver dz w fatty infiltration
obesity
DM
steroids
What are infectious causes of hepatomegaly?
hepatitis
hydatid disease
What are infiltrative and metabolic causes of hepatomegaly?
sarcoidodis amyloidosis haemachromatosis wilson's disease cysts of PCKD
What are obstructive causes of hepatomegaly?
right heart failure
budd chiari
biliary tract obstruction
What are causes of hepatosplenomegaly?
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
What are causes of a firm and irregular liver?
Cirrhosis
Metastatic disease
Hydatid disease, granuloma, amyloid, cysts, lipoidoses
What are causes of a tender liver?
Hepatitis
Rapidly enlarging liver - RHF, Budd chiari
HCC
What are causes of a pulsatile liver?
Tricuspid regurgitation
HCC
Vascular abnormalities
What are causes of bilateral renal masses?
PCKD Hydronephrosis/pyonephrosis Hypernephroma (bilat RCC) Acute renal vein thrombosis (bilat) Amyloid, lymphoma, other infilt Acromegaly
What are causes of unilateral renal masses?
RCC Hydronephrosis or pyonephrosis PCKD (asymmetric) Acute renal vein thrombosis Normal right kidney, or solitary kidney (uncommon)
What are findings on general inspection in PKD?
sallow complexion
AVF or subclavian catheter
Hyperventilation (Acidosis), malnutrition
Scars or skin cancers if renal transplant present
What are features on abdominal examination in PKD?
Inspection - scars, tenkhoff, excoriation
Palpations - palpable kidneys, palpable liver (cysts)
Abdominal wall/inguinal hernia
Transplanted kidney
NO SPLENOMEGALY
What are features of palpable kidneys?
- can feel upper pole/get above
- ballotable
- moves inferiorally on inspiration
- resonant percussion note if bowel overlying
- no notch
- no friction rub
What are features on hand/arm exam in PKD?
nail changes - distal brown arc
anaemia
uraemic flap
hypertension
What are features on neck exam in PKD?
elevated JVP
parathyroidectomy scars
What are features on CV examination in PKD?
mitral valve prolapse in 25%, AR and TR also increased
Pericarditis - uraemic
What are findings on examination of the LL in PKD?
peripheral oedema, peripheral neuropathy, gout
What are other findings in PKD?
urinalysis for haematuria
fundoscopy (HTN changes)
ECG for LVH evidence
What are associations with PCKD?
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
What are SEs in transplant patients receiving steroids?
Osteoporosis Proximal myopathy cataracts Diabetes Cushings Hypogonadism Infections
What are causes of RIF masses?
Appendiceal abscess Caecal carcinoma Crohn's disease Pelvic kidney Ovarian tumour/cyt Carcinoid tumour Amoebiasis Psoas abscess Ileocaecal tuberculosis
What are causes of LIF masses?
Faeces (can be indented) Carcinoma of sigmoid/descending colon Diverticular disease Ovarian tumour/cyst Psoas abscess
What are causes of upper abdominal masses?
Retroperitoneal LA Abdominal aortic aneurysm Carcinoma of stomach Pancreatic pseudocyst/tumour Pyloric stenosis Carcinoma of t'verse colon
What are causes of massive splenomegaly?
CML
myelofibrosis
primary lymphoma of spleen, hairy cell leukaemia, malaria, kala-azar (all rare)
What are causes of moderate splenomegaly?
as for massive + portal hypertension lymphoma leukaemia (chronic/acute) thalassaemia storage diseases (gaucher's disease)
What are causes of small splenomegaly?
As per moderate and large + PCV, ET haemolytic anaemia megaloblastic anaemia (rare) infection - EBV, hepatitis, IE CTD/Vasculitis - RA, SLE, PAN Infiltration - amyloidosis, sarcoidosis
