Hepatomegaly

Question 1

Signs of hepatomegaly

Answer 1

Mass in RUQ, moves with resp., dull to percussion, unable to get above
Estimate size
Smooth or craggy/nodular (malignancy/cirrhosis)
Auscultation (bruit= HCC)

Question 2

Signs of chronic liver disease

Answer 2

Cachexia, icterus, excoriation, bruising
Leuconychia, palmar erythema, dupuytron’s, clubbing
Foetor hepaticus, xanthelasma, parotid swelling
Spider naevi, loss of body hair, gynaecomastia, caput medusa, testicular atropy

Question 3

Signs of causes of hepatomegaly

Answer 3

Infectious hepatitis: tattoos, needle marks
Chronic HF: midline sternotomy
Haemochromatosis: pigmentation
Malignancy: cachexia

Question 4

Signs of hepatic decompensation

Answer 4

Ascites: shifting dullness
Encephalopathy: asterixis, reduced GCS, slurred speech, altered mood/behaviour
Jaundice: icteric sclera
Foetor hepaticus

Question 5

Causes of liver failure

Answer 5

Infections: viral hepatitis, yellow fever, leptospirosis
Drugs: paracetamol OD, halothane, isoniazid
Toxins: amanita phalloides, carbon tetrachloride, alcohol
Vasc: BuddChiari synd., veno occlusive disease
AI: PBC, haemochromatosis, Wilsons, alpha1antitrypsin, HELLP/fatty liver of pregnancy, malignancy

Question 6

Causes of hepatomegaly

Answer 6

Cirrhosis
Carcinoma- mets
Congestive HF
Immune: PBC, PSC, AIH
Infection: hep B + C
Infiltrative: myeloproliferative or amyloid

Question 7

Investigations

Answer 7

Bloods: FBC, clotting, U+Es, LFTs, glucose
Abdominal USS
Ascitic tap: MC&S, protein, glucose, amylase, ALP, triglyceride, WCC, RCC

Question 8

Investigating cirrhosis

Answer 8

Liver screen: Hep B + C serology, ferritin (HH), Caeruloplasmin, alpha1antitrypsin, AFP(HCC),
Synthetic function testing: INR, albumin
Biopsy: true diagnosis + staging
ERCP: for PSC

Question 9

Investigating malignancy

Answer 9

CXR
CT abdo + chest
Colonoscopy/OGD
Biopsy

Question 10

Complications of cirrhosis

Answer 10

SBP
Variceal bleeding: portal htn and deranged haemostasis
Hepatic encephalopathy

Question 11

Child Pugh score in cirrhosis

Answer 11

Albumin
Bilirubin
Clotting
Encephalopathy
Fluid aka ascites

Question 12

Causes of ascites

Answer 12

Cirrhosis = majority
Carcinoma
Chronic HF

Question 13

Treating ascites

Answer 13

Stop drinking
Diuretics
No salt in diet
Liver transplant

Question 14

Causes of palmar erythema

Answer 14

Cirrhosis
Pregnancy
RA
Hyperthyroidism
Polycythaemia

Question 15

Causes of gynaecomastia

Answer 15

Cirrhosis
Drugs: spiro, dig
Testicular tumour
Kleinfelters
Addisons
Hypo/hyperthyroid