GIT exam Flashcards
Cushingoid appearance
Features and causes
Wt☝🏼 hirsuit 🦍 striae
Steroids (IBD, CAH)
Cyclosporine (tx rejection)
Tacrolimus (stop rejection)
Signs of portal HTN
Ascites
Solenomegaly
Caput medusae
Anorectal varicies
LFTs - hepatic markers
AST (+heart, skeletal muscle, RBCs, kidney, brain)
ALT (more specific liver and kidney)
LFTs: Cholestatic markers
ALP
GGT
Wilson’s disease
Eyes, liver, brain, kidney
Diagnosis
Copper transport defect - builds up
- eye: kaiser-fleischer rings
- liver: 5 yo +, hepato +/- splenomeg
- brain: 10 yo +, copper deposition in basal ganglia, tremors, sz, behavioural change
- kidney: proximal RTA
Diagnosis
Urine 24 hr copper excretion (up)
Serum copper: raised or normal
Serum ceruloplasmin: down (binds copper)
Peutz-jager signs
Hypermelanotic macules - lips, palms, soles
AD
GIT polyps
Increased risk cancer
Intussusception
Peripheral stigmata chronic liver disease
Pallor
Spider naevi, caput medusae
Xanthomata
Petechiae
Clubbing, leuconychia
Palmar erythema
Ascites
Xanthelasma - CLD
Xanthomata - CLiver D
1, 2, 3
- RUQ - liver: biopsy, t/p, biliary - kasai procedure
- Upper midline lap scar: fundoplication (look for PEG), early renal t/p
- Transverse upper abdo: CDH, splenectomy
4, 5, 6
- Below umb: gastroschisis, hernia repair, omphalocele (BWS)
- Port, drain, VP shunt, PD
- LIF colostomy RIF iliostomy
7, 8, 9
- RLQ - kidney t/p
- RIF - appendectomy
- Loin/ renal angle - neohrectomy, kidney biopsy
Congenital diaphragmatic hernia associations
Trisomies
Turner
Frynns syndrome: underdevelopment of nails and finger bones, hypertelorism, cleft palate
Hepatomegaly + jaundice DDx
Infants:
- biliary atresia, choledocal cyst (kasai scar)
- alagille: butterfly vertebrae, PS, triangular face, deep set eyes, vit ADEK, test: MA, clinical exome with JAG1+ NOTCH2
Infection: echovirus 11, TORCH, UTI ecoli
Alpha-1-antitrypsin
Chronic active hep
Wilson disease
Haemolysis
Hepatomegaly + jaundice Invx
Bloods: LFTs, coags + albumin (synthetic function), FBC + film (haemolysis), A1AT assay + Pi phenotype
Hep ABC serology, TORCH serology
CMV serology +/urine
Wilson: copper and ceruloplasmin
Liver US
HIDA scan (gallbladder, bile ducts)
Jaundice - haem causes
Sickle cell disease
Hereditary spherocytosis (EMA binding test)
Autoimmune haemolytic anaemias (positive direct Coombs)
G6PD
Jaundice - no HSM or haemolysis
Gilbert’s
Increased unconj bili during attacks
Causes unconjugated hyperbilirubinaemia
Before the liver problem
Haemolysis
Impaired conjugation: Gilbert’s, Crigler-Najjar
Causes conjugated hyperbili
In the liver or gallbladder / bile duct problem
Extrahepatic bile duct obstruction
- biliary atresia
- choledochal cyst
Dubin-Johnson Syndrome: bili excretion defective
Alagille: intrahepatic biliary atresia
Heptocyte injury
- A1AT
- CF
- Hepatitis
- Glycogen storage disease (UMS)
Hepatomegaly and not jaundiced DDx
Mass
- hepatoblastoma
- Wilm’s (nephroblastoma)
- secondary NB
*all more common BWS
Congenital hepatic fibrosis (infants)
Metabolic (infants)
Lysosomal storage disorder, galactosemia
Chronic disease: CF, CCF
Infection: hep a - e, EBV, CMV, toxoplasmosis
Rheum - SLE, RA
IBD
Hepatomegaly and not jaundiced invx
Bloods: LFTs, coags, albumin, EUC, FBC, CRP (infection)
TORCH serology
Hep A-e serology
CMV blood and urine
BWS: methylation studies
IBD tests: stool fat crystals, fecal calprotectin
CF: sweat chloride test, r/v NBST
Imaging: liver US
Rheum: dsDNA, ANA, HLA type
Splenomegaly alone and jaundice DDx
Haemolytic process
Infections
- typhoid
- septicaemia
- subacute bacterial endocarditis
Masses
- splenic cyst
- Splenic harmatoma
Malignancy:
- leukaemia
- lymphoma
Spleen US
UA - what are you looking for in abdo exam?
Bilirubin: hepatic disease
Urobilinogen: hepatic dysfunction
IBD investigations
Bloods: FBC (low Hb, high WCC plts)
ESR CRP up
EUC CMP
LFTs
Nutritional screen
Stool:
Gross or occult blood
Fecal calprotectin (up)
Mc+s
Endoscopy for diagnosis
A1T1
Defective secretion protein x from hepatocyte
Presents: jaundice, acholic stools, hepatomegaly
Invx
- serum alpha 1 AT, Pi phenotype (Piss, Pinull null or PiZZ = disease)
- liver US + biopsy
