Abdomen Flashcards
(16 cards)
What is a normal liver span?
11 - 14 cm.
What size is massive hepatomegaly and what are the causes?
A span > 20 cm is massive hepatomegaly.
Malignancy
Hepatoma
Metastases from another primary
Myeloproliferative disorders: myelofibrosis, dysplasia, CML
Hepatic pathologies
Hepatoma
Other
Tricuspid regurgitation (pulsatile hepatomegaly)
What size is moderate hepatomegaly and what are the causes?
A span of 15 - 20 cm is moderate hepatomegaly.
Malignancy
Myeloproliferative: Myelofibrosis / myelodysplasia / CML
Liver metastases
HCC
Primary liver pathologies
NAFLD
Haemachrmatosis
What are the sizes of splenomegaly?
1-2 cm mild splenomegaly
3-7 cm moderate splenomegaly
>7cm marked splenomegaly
What are the sizes and causes of marked splenomegaly?
>7cm = marked splenomegaly
Malignancy
Myelofibrosis, CML, Myelodysplasia
What are the sizes and causes of moderate splenomegaly?
3-7 cm = moderate splenomegaly
Malignancy
Myeloproliferative disorders: myelofibrosis, dysplasia, CML, PRV
Lymphoma, CLL
Hepatic
Portal HTN (with CLD liver may be small)
What causes hepatosplenomegaly?
Cirrhosis is usually = small liver + splenomegaly
NAFLD, EtOH liver disease, haemachromatosis, HCC causes hepatosplenomegaly
or
infiltrative diseases (lymphoma, amyloid, CTDs)
or
haematological malignancies (myelofibrosis / dysplasia) causes massive hepatosplenomegaly
What are the signs of portal hypertension?
Splenomegaly
Ascites
Prominent paraumbillical veins
History of oesophageal / rectal varicies
What are the peripheral stigmata of EtoH related liver disease?
Dupuytren’s contracture
Parotidomegaly
What are the sizes and causes of mild splenomegaly?
1-2 cm = mild splenomegaly
Malignancy
Myeloproliferative disorders: myelofibrosis, dysplasia, CML, PRV, ET
Lymphoma, CLL
Hepatic
Portal HTN (with CLD liver may be small)
Other
CTDs (RA)
ITP, Thalassaemia, Sickle Cell
Sarcoid, Amyloid
How do you differentiate splenomegaly from a left renal mass
Spleen
- Moves inferiorly and medially on inspiration
- Not ballotable
- Notch in upper margin (if moderate splenomegaly), and can’t get above
- Dullness in Traube’s space
Renal mass
- Moves inferiorly on inspiration
- Ballotable
- No notch, and can’t get above
- No dullness in Traube’s space
How to present exam findings of liver pathology.
In regard to the aetioloigy of the underlyig CLD
Dupetryn’s / Parotidomegaly
Signs of decompensated liver disease
Ascites / SBP
Hepatic encephalopathy
HCC
HRS
HPS
Or state there is no evidence of decompensation
Signs of portal HTN
Ascites
Splenomegaly
Caput medusae / enlarged paraumbilical veins
Other signs of CLD
Palmar erythema / Spider naevi
Jaundice
Presenting renal findings on exam
Aetiology of CKD
Ballotable masses (PCKD)
Complications of CKD
Fluid overload
Pruritis
HTN
Pale conjunctivae / palmar creases anaemia
Treatment of CKD
AVF
Tenkhoff catheter
How to describe an undifferentiated abdominal mass
Location
Size
Consistency (soft, firm)
Tender, non-tender
Move with respiration?
Pulsatile?
Associated rub or bruit?
Percussion note (resonant or dull)?
What are the relevant positives or negatives to note in the presence of an undifferentiated abdominal mass?
Cachexia
Evidence of anaemia (pallor of the palmar creases, pale conjunctivae)
Presents of lymphadenopathy (especiqally left supraclavicular fossa - Vurchowv’s node)
