Abdominal Exam Findings

Question 1

Hepatomegaly characteristics to note

Answer 1

1. nodular/smooth
2. firm, hard
3. pulsatile
4. tender

Question 2

What is hepatomegaly?

Answer 2

> 12.5cm

Question 3

What are the causes of massive hepatomegaly

how would you identify the etiology in the patient on the day

Answer 3

Metastases
Alcoholic
Myeloproliferative disease
Right heart falure
Hepatocellular cancer

so essentially
Cancer: mets, hcc, mpd: lymph nodes, anaemia, ascites
Alcohol: parotidomegaly
RHF: JVP, P2

Question 4

Mild hepatomegaly

Answer 4

Infection: Hepatitis (tender), hiv
infiltration: sarcoid, amyloid
haemochromatosis
CML: lymphoma
NAFLD

Question 5

Causes of massive splenomegaly

Answer 5

CML
Myelofibrosis
Primary lymphoma: rare

Question 6

Other causes of mild/moderate splenomegaly

Answer 6

portal HTN - ascites
leukaemia - LN
haemolytic anaemias (jaundice anyone?)
CTD like RA - hand signs

Question 7

Pattern of pathology on walking in
Haematologic abdomen
Renal abdomen
CLD
GI

Answer 7

Haem: bald, LN’s
Renal: AVF
CLD: ascites, jaundice, haemochromatosis
GI: stoma, telangiectasia

Question 8

Extending the examination

CLD portal HTN

Answer 8

caput medusae
splenomegaly
hum over liver

Question 9

CLD decompensation

Answer 9

jaundice, purpura
encephalopathy
ascites
portal htn

Question 10

CLD etiology

Answer 10

alcohol: parotidomegaly, dupuytren *
haemochromatosis: grey skin
hepatitis: tattoos, track marks
alpha 1 AT: obstructive lung disease*
wilson: KF ring *

Question 11

CLD features

Answer 11

clubbing
palmar erythema*
leukonychia
pruritis
spider naevi
gynecomastia

pallor/ koilonychia*
sarcopaenia*
lack of body hair