Cases for PACES Flashcards
What are the clinical signs of chronic liver disease?
- Excoriation (skin picking)
- Dupuytren’s Contracture
- Palmar Erythema
- Parotid Swelling
- Fetor Hepaticus (breath of the dead - characteristic breath of patients with severe hepatic parenchymal disease, an odor likened to a mixture of rotten eggs and garlic)
- Chest & Abdomen
- Spider Naevi
- Caput Medusa
- Testicular Atrophy
What are the signs of hepatomegaly on examination?
Palpation + Percussion
- RUQ mass
- moves w respiration
- cannot get above
- dull percussion
- estimate size - finger breadths below diaphragm
- smooth OR craggy/nodular (malignancy vs cirrhosis)
- pulsatile? (tricuspid regurgitation in chronic cardiac failure)
- Bruit over liver? (hepatocellular carcinoma)
What evidence of treatment can be seen in chronic liver failure?
- Ascitic Drain/Tap Sites
- Surgical Scars
What evidence can you look for to determine an underlying cause for hepatomegaly?
- Tattoos + Needle Marks –> Infectious Hepatitis
- Slate-Grey Pigmentation –> Haemochromatosis
- Cachexia –> Malignancy
- Mid-Line Sternotomy Scar –> Congestive Cardiac Failure (CCF)
What is decompensated liver disease?
- Compensated = no cirrhosis signs/symptoms (may have portal hypertension –> oesophageal/gastric varices)
- Decompensated = symptomatic complications due to 1) hepatic insufficiency (jaundice, encephalopathy) + 2) portal hypertension (ascites, variceal haemorrhage)
What are the evidence of decompensated liver disease?
- Ascites - shifting dullness
- Asterixis - liver flap
- Altered consciousness (encephalopathy)
What are the causes of hepatomegaly?
The Big 3 C’s
- Cirrhosis –> alcohol
- Carcinoma –> secondaries
- Congestive Cardiac Failure
The Small 3 I’s
- Infectious –> HBV, HCV
- Immune –> PBC, PSC, AIH
- Inflitrative –> amyloid, myeloproliferative disorders (PRV)
What are the investigations for hepatomegaly?
- U&Es (creatinine produced in liver; urea decreases in liver disease)
USS –> abdomen
Ascites Tap (if present)