Abdomen Cases Flashcards
(7 cards)
Chronic liver disease/Hepatomegaly
Causes of CLD: ARLD; MASH; Hep B/C; Autoimmune; PBC;PSC; Wilson’s; Haemochromatosis; alpha-1 antitrypsin; drugs
Investigations: FBC, CRP, U&Es, LFTs; clotting; glucose; anti-mitochondrial M2, anti-smooth muscle, ANA; anti-liver/kidney microsomal type and ANAalpha1 antitrypsin antibodies; hepatitis serology; ferritin and iron studies; caeruloplasmin and urinary copper; AFP; ascitic tap; USS abdomen; liver biopsy; ERCP (PSC); OGD; CT for malignancy
Rx: no alcohol, high protein low salt diet; diuretics; daily weights; paracentesis; liver transplant
Prognosis: child Pugh score
Causes of palmar erythema
Cirrhosis
Hyperthyroidism
Rheumatoid arthritis
Pregnancy
Polycythaemia
Haemochromatosis
Exam: 2nd/3rd metacarpals joints; pseudogout; slate grey; hypogonadism; CCF; CLD/hepatomegaly
Ix: routine bloods, glucose, ferritin, transferrin saturation, alpha feta protein; USS; genotyping
Rx: venesection until iron deficient; avoid alcohol; HCC surveillance;
Inheritance: autosomal recessive, HFE gene; iron studies then if positive biopsy and genotype analysis
Causes of gynaecomastia
Puberty
Kleinfelters
Cirrhosis
Spiro/digoxin
Testicular tumour, orchidectomy
Thyroid, addisons
Causes of hepatomegaly
ARLD
MDASH
Hep BC
Autoimmune hepatitis
PBS, PBC
Wilson’s
Haemochromatosis
Splenomegaly
Causes:
Big:CML, myelofibrosis, malaria, visceral leishmaniasis,
Medium:myelo/lymphoproliferative, gauchers, amyloidosis,
Small: portal hypertension, EBV, IE, infective hepatitis, haemolytic anaemia
Ix
FBC, film, viral serology
USS abdo, CT Chest/abdomen,
Bone marrow biopsy, trephine
Lymph node biopsy
Rx
Rupture/ITP/hereditary spherocytosis - splenectomy
Prior to splenectomy - vaccination (pneumococcus/meningococcus/haemophilus); prophylactic penicillin; medical alert bracelet
Renal enlargement
Unilateral causes: PKD, renal cell carcinoma, simple cyst, hydronephrosis
Bilateral: PKD, bilateral renal cell carcinoma (5%), bilateral hydronephrosis, tuberous sclerosis, amyloidosis
Ix: urine dip, renal function, urine cytology, USS abdo, biopsy, urographie, CT if carcinoma, genetic studies
