Examination - Abdominal Flashcards
(41 cards)
What are the five F’s that can cause ascites?
Flatus Faeces Foetus Fat Fluid
What is the main differential of a swollen abdomen with jaundice?
CLD - may have signs of decompensation
Transplant failure - rooftop scar
What are the signs of chronic liver disease?
GENERAL
- Cachexia
- Jaundice
- Excoriciations
- Bruiding
- Lack of axillary hair
HANDS
- Dupuytren’s contracture
- Palmar erythema
- Clubbing
FACE
- Icteric sclera
- Parotid swelling
Abdomen
- Spider naevi
- Hepatomegaly/splenomegaly
- Ascites
- Gynaecomastia
- Caput medusae
What causes spider naevi?
Anything that results in a rise of oestrogen e.g. CLD, pregnancy, gynaecomastia
What are the causes of Dupuytren’c contracture?
Trauma Alcoholic liver disease Valproate Manual labour Peyronie's Epilepsy DM
What could be causing CLD in a patient with needle marks or a tattoo?
Hep C
What could be causing CLD in a patient with parotid swelling?
Alcohol
What could be causing CLD in a patient with a bronzed complexion or insulin injection sites?
Haemochromatosis
What could be causing CLD in a patient with obesity/diabetes?
Non-alcoholic fatty liver disease
What could be causing CLD in a patient with xanthelasma?
Cholestatic disorder
What does asterixis (flapping tremor) indicate in chronic liver disease patients?
Hepatic encephalopathy
What are the causes of chronic liver disease?
INFECTIVE
- Hep B
- Hep C
TOXIC
- Alcohol
METABOLIC
- Non-alcoholic fatty liver disease
- Haemochromatosis
- Alpha-1-antirtypsin deficiency
- Wilson’s disease
AUTOIMMUNE
- Autoimmune hepatitis
- Primary sclerosing cholangitis
- Primary biliary cirrhosis
What are the common features of decompensated liver disease?
Decompensation happens if there is a synthetic or metabolic malfunction of the liver i.e. it can no longer compensate for the damage.
A-G of decompensated liver disease
- Ascites
- Bile
- Coagulopathy
- Vitamin D
- Encepthalopathy [asterexis]
- Factor deficiencies
- GI varicies due to portal HTN
What blood tests would you do to help to determine the cause of chronic liver disease?
- Infection –> HBV and HCV serology
- Metabolic –> Ferritin, transferrin, A1AT, caeruloplasmin
- Autoimmune –> immunoglobulins, autoantibodies
What are the complications of cirrhosis?
PORTAL HTN
- variceal haemorrhage
- spontaneous bacterial peritonitis due to ascitic collection being stagnant
- thrombocytopenia
HEPATOCELLULAR FAILURE
- encephalopathy
- hepatocellular carcinoma
- hypoalbuminaemia
- coagulopathy
What is the main differential for a patient with a swollen abdomen, pallor and dullness in Traube’s space?
Splenomegaly
What are the causes of splenomegaly?
‘M’assive splenomegaly
- Malaria
- chronic Myeloid leukaemia
- Myelofibrosis
Others
- Spherocytosis
- EBV
- Portal hypertension
- Infiltration (amyloidosis)
- Sarcoidosis
What are the indications for splenectomy?
- Traumatic rupture
- Idiopatthic thrombocytopenia - remove spleen as it destroys platelets
- Spherocytosis
What treatments are required following splenectomy?
Spleen helps with immunity against encapsulated organisms so you must protect against them:
- Pneumococcus meningococcus
- Haemophilus influenzae B
> > Penicillin V prophylaxis
Which type of patients commonly have arterio-venous fistulas?
Renal patients receiving dialysis
How do you tell if an AV fistulae is still active?
Needle marks
Bandages
Ask the patient
In what situation would you get a nephrectomy scar?
Usually diseased kidneys are left in the body but if they are polycystic and causing obstruction, it will have been removed.
Where can renal transplants be felt on palpation?
Right iliac fossa
What kind of scar is seen in a renal transplant?
Oblique iliac fossa scar
