Abdo Short

Question 1

Signs of alcoholic liver disease (7)

General inspection (2)

Hands (2)

Neuromuscular (3)

Answer 1

Cachexia

Parotid enlargement

Tremor

Dupuytren’s contracture

Cerebellar syndrome

Peripheral neuropathy

Myopathy

Question 2

Peripheral signs of chronic liver disease

General inspection and face (3)

Answer 2

Cachexia

Jaundice - scleral icterus

Anaemia - conjunctival pallor

Question 3

Peripheral signs of chronic liver disease

Hands (3)

Answer 3

Clubbing

Leuconychia (low albumin state)

Palmar erythema

Question 4

Peripheral signs of chronic liver disease

Chest (3)

Answer 4

Spider Naevi

Gynaecomastia

Loss of body hair

Question 5

Causes of cirrhosis (5 broad categories)

Answer 5

Alcohol

Viral - Chronic Hep B and Hep C

Autoimmune - hepatitis, PBC, PSC

Metabolic - NASH, HHC, A1 antitrypsin deficiency, Wilson’s

Drugs - Methotrexate, Isoniazid, Amiodarone, Phenytoin

Question 6

Consequences of portal hypertension (3)

Answer 6

Oesopageal varices

Ascites

Hypersplenism / Thrombocytopaenia

Question 7

Consequences of liver dysfunction (4) + (1)

Answer 7

Coagulopathy

Encephalopathy

Jaundice

Hypoalbuminaemia

Hepatocellular Carcinoma

Question 8

Child Pugh Score Components (5)

Answer 8

Bilirubin <35 to > 52

Ascites

Encephalopathy

PT (INR)

Albumin >35 to < 28

Question 9

Child Pugh Mortality

A

B

C

Answer 9

Child Pugh A 5-6: 90% survive 5 years

Child Pugh B 7-9: 80% survive 5 years

Child Pugh C 10: 33% one year mortality

Question 10

Most common causes of ascites (5)

Answer 10

Cirrhosis

Malignancy

Heart failure

Tuberculosis

Pancreatitis

Question 11

What is the Serum albumin - ascites gradient?

And what does it mean?

Answer 11

SA-AG = serum albumin - ascites albumin

if SA-AG > 11 = transudative

Ascites likely due to portal hypertension

if SA-AG < 11 = exudative

Ascites likely due to other causes other than portal HTN,
heart failure or veno-occlusive disease

Question 12

Causes of hepatomegaly (5)

without splenomegaly

Answer 12

Viral hepatitis

Alcoholic hepatitis

Malignancy

Hepatic congestion (from cardiac fialrue)

Vascular liver disease (Budd-Chiari syndrome)

Question 13

Causes of MASSIVE splenomegaly (5)

Answer 13

Chronic Myeloid Leukamia (CML)

Myelofibrosis

Splenic lymphoma

Malaria

Kala-azar

Question 14

Causes of moderate splenomegaly (5)

Answer 14

Portal hypertension

Lymphoma

Leukaemia (acute or chronic)

Thalassaemia

Glycogen and lipid storage disease (Gaucher’s disease)

Question 15

Causes of mild splenomegaly (5)

Answer 15

Other myeloproliferative diseases (PRV)

Haemolysis

Infection (HIV, EBV, infectious endocarditis)

Autoimmune Disease (RA, SLE)

Infiltrative conditions (Amyloid, Sarcoid)

Question 16

RIF abdominal masses (5)

Infectious (3)

Malignant (2)

Other (2)

Answer 16

Appendiceal abscess

Psoas abscess

Ileocaecal TB

Caecal cancer

Ovarian tumour

Crohn’s Disease

Pelvic kidney

Question 17

LIF Abdominal masses (5)

Answer 17

Faeces (indent)

Sigmoid / colon cancer

Diverticular Disease

Psoas abscess

Ovarian tumour

Question 18

Upper abdominal mass

Features of normal organs (Liver / Spleen / Kidneys)

Pulsatile mass?

GI masses?

Other types of masses?

Answer 18

Liver - moves down with respiration, can’t get above

Spleen - moves down with respiration, can’t get above

Kidneys - balottable

AAA - pulsatile mass

Others: Stomach / Colon / Pancreatic

Retroperitoneal lymphadenopathy - lymphoma / teratoma

Question 19

Polycystic kidney disease

Clinical features (4)

Answer 19

Bilateral flank masses

Irregular in shape

Able to get above

Does not move with respiration

Question 20

What are the extra-renal manifestations of
Autosomal dominant polycystic kidney disease?

Brain

Liver

Heart

Answer 20

Cerebral aneurysms

Liver cysts (+/- pancreas, ovary, spleen)

Valvular heart disease - MVP and AR

Question 21

Differentials for bilateral flank masses? (4)

Answer 21

Simple renal cysts

Bilateral hydronephrosis

Amyloidosis

Von Hipple Lindau syndrome

Question 22

Complications of polycystic kidney disease

Pain

Answer 22

Pain secondary to stretching of the renal capsule

Acute flank pain - suggestive of haemorrhage or infection

If recurrent - consider nephrectomy!