Abdo Short Flashcards
Signs of alcoholic liver disease (7)
General inspection (2)
Hands (2)
Neuromuscular (3)
Cachexia
Parotid enlargement
Tremor
Dupuytren’s contracture
Cerebellar syndrome
Peripheral neuropathy
Myopathy
Peripheral signs of chronic liver disease
General inspection and face (3)
Cachexia
Jaundice - scleral icterus
Anaemia - conjunctival pallor
Peripheral signs of chronic liver disease
Hands (3)
Clubbing
Leuconychia (low albumin state)
Palmar erythema
Peripheral signs of chronic liver disease
Chest (3)
Spider Naevi
Gynaecomastia
Loss of body hair
Causes of cirrhosis (5 broad categories)
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
Consequences of portal hypertension (3)
Oesopageal varices
Ascites
Hypersplenism / Thrombocytopaenia
Consequences of liver dysfunction (4) + (1)
Coagulopathy
Encephalopathy
Jaundice
Hypoalbuminaemia
Hepatocellular Carcinoma
Child Pugh Score Components (5)
Bilirubin <35 to > 52
Ascites
Encephalopathy
PT (INR)
Albumin >35 to < 28
Child Pugh Mortality
A
B
C
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
Most common causes of ascites (5)
Cirrhosis
Malignancy
Heart failure
Tuberculosis
Pancreatitis
What is the Serum albumin - ascites gradient?
And what does it mean?
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
Causes of hepatomegaly (5)
without splenomegaly
Viral hepatitis
Alcoholic hepatitis
Malignancy
Hepatic congestion (from cardiac fialrue)
Vascular liver disease (Budd-Chiari syndrome)
Causes of MASSIVE splenomegaly (5)
Chronic Myeloid Leukamia (CML)
Myelofibrosis
Splenic lymphoma
Malaria
Kala-azar
Causes of moderate splenomegaly (5)
Portal hypertension
Lymphoma
Leukaemia (acute or chronic)
Thalassaemia
Glycogen and lipid storage disease (Gaucher’s disease)
Causes of mild splenomegaly (5)
Other myeloproliferative diseases (PRV)
Haemolysis
Infection (HIV, EBV, infectious endocarditis)
Autoimmune Disease (RA, SLE)
Infiltrative conditions (Amyloid, Sarcoid)
RIF abdominal masses (5)
Infectious (3)
Malignant (2)
Other (2)
Appendiceal abscess
Psoas abscess
Ileocaecal TB
Caecal cancer
Ovarian tumour
Crohn’s Disease
Pelvic kidney
LIF Abdominal masses (5)
Faeces (indent)
Sigmoid / colon cancer
Diverticular Disease
Psoas abscess
Ovarian tumour
Upper abdominal mass
Features of normal organs (Liver / Spleen / Kidneys)
Pulsatile mass?
GI masses?
Other types of masses?
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
Polycystic kidney disease
Clinical features (4)
Bilateral flank masses
Irregular in shape
Able to get above
Does not move with respiration
What are the extra-renal manifestations of
Autosomal dominant polycystic kidney disease?
Brain
Liver
Heart
Cerebral aneurysms
Liver cysts (+/- pancreas, ovary, spleen)
Valvular heart disease - MVP and AR
Differentials for bilateral flank masses? (4)
Simple renal cysts
Bilateral hydronephrosis
Amyloidosis
Von Hipple Lindau syndrome
Complications of polycystic kidney disease
Pain
Pain secondary to stretching of the renal capsule
Acute flank pain - suggestive of haemorrhage or infection
If recurrent - consider nephrectomy!
