DDx Massive hepatomegaly
- Mets
- alcoholic liver disease with fatty infltrate
- myeloproliferative disease
- RHF
- HCC
DDx Moderate hepatomegaly
- Mets
- alcoholic liver disease with fatty infltrate
- myeloproliferative disease
- RHF
- HCC
Plus
- Haemachromatosis
- CML, Lymphoma
- Fatty liver - obesity, diabetes, toxins
DDx mild hepatomegaly
- Mets
- alcoholic liver disease with fatty infltrate
- myeloproliferative disease
- RHF
- HCC
Plus
- Haemachromatosis
- CML, Lymphoma
- Fatty liver - obesity, diabetes, toxins
Plus
- Hepatitis
- Cirrhosis
- Biliary obstruction
- Granulomatous disorders
- Hydatid disease
- Amyloidosis and other infiltrative diseases
- HIV
- Ischemia
DDx firm and irregular liver
Cirrhosis
Mets
Hydatid disease, granuloma, amyloid, cysts, lipoidoses
DDx tender liver
hepatitis
Rapid liver enlargement - RHF, Budd-Chiari syndrome
HCC
DDx Pulsatile liver
TR
HCC
Vascular abnormalities
DDx Bilateral renal masses
PCKD Hydronephrosis or pyonephrosis Hypernephroma (bilateral RCC) Acute renal vein thrombosis (bilateral) Amyloid, lymphoma, other infiltrative disease Acromegaly
DDx unilateral renal mass
RCC Hydronephrosis or pyonephrosis PCKD Acute renal vein thrombosis Normal right kidney or a solitary kidney
RIF masses
Appendicieal abscess Carcinoma of caecum Crohns disease Pelvic kidney Ovarian tumor or cyst Carcioid tumor Amoebiasis Psoas abscess Ileocecal TB
LIF masses
Faeces Carcinoma of sigmoid or descending colon Diverticular disease Ovarian tumor or cyst Psoas Abscess
Upper abdo mass
Carcinoma of stomach
Carcinoma of transverse colon
Pancreatic pseudocyst or tumor
AAA
Retroperitoneal lymphadenopathy
Pyloric stenosis
DDx massive splenomegaly
CML
myelofibrosis
primary lymphoma of spleen, hairy cell leukemia, malaria, kala-azar
DDX Moderate splenomegaly
CML
myelofibrosis
primary lymphoma of spleen, hairy cell leukemia, malaria, kala-azar
Plus
- portal HTN
- Lymphoma
- Leukemia
- Thalassemia
- Storage diseases (Gaucher’s)
DDx mild splenomegaly
CML
myelofibrosis
primary lymphoma of spleen, hairy cell leukemia, malaria, kala-azar
Plus
- portal HTN
- Lymphoma
- Leukemia
- Thalassemia
- Storage diseases (Gaucher’s)
Plus
- myeloproliferative diseases - PRV, ET
- Haemolytic aneamia
- megaloblastic anaemia
- Infection: Viral (mono, hepatitis), bacterial (IE)
- CTD - RA, SLE, PAN
- Infiltration - Amyloid, sarcoid
Causes of hepatosplenomegaly
- CLD with Portal HTN
- Haematological disease - myeloproliferative disease, lymphoma, leukemia, pernicious anaemia, sickle cell anaemia
- Infection: CMV, EBV, HIV
- Infiltration - Amyloidosis, sarcoid
- CTD - SLE
- Acromegaly
- Thyrotoxicosis
Distinguishing a spleen from a kidney
- Spleen has no palpable upper border
- Spleen has a notch
- Spleen moves inferolaterally on respiration
- No resonance over splenic mass
- Spleen is not bimanually palpable (not ballotable)
- Friction rub may occasional be heard over a spleen
Causes of Generalised Lymphadenopathy
- Lymphoma (rubbery and firm)
- Leukemia (CLL, ALL particularly)
- Malignant disease
- Infections (Viral, bacterial, protozoal)
- CTD - RA and SLE
- Infiltrative - Sarcoid
- Drugs - Phenytoin (pseudolymphoma)
What is the definition of mild hepatomegaly?
12cm - 15cm
What is the definition of moderate hepatomegaly?
15cm - 20cm
What is the definition of massive hepatomegaly?
> 20cm
What bedside tests would you do to complete a Gastrointestinal exam?
- Complete examination: inguinoscrotal (LAD, masses, testicular atrophy), rectal exam (bleeding, masses), cardio-respiratory (fluid status) + additional modules as relevant (e.g. alcohol, malignancy)
- Vital signs: temperature (fevers/infection), oxygen saturation
- Urinalysis: bilirubin (liver disease), glucose (diabetes/haemachromatosis)
Causes of ascites with SAAG >11
Indicates portal HTN which is a transudative process
Causes:
- Cirrhosis
- Hepatic failure
- Budd chiari
- Portal vein thrombus
- Cardiac failure
- Constrictive pericarditis
Causes of ascites with SAAG < 11
- Malignancy
- Infection
- Pancreatitis
- Nephrotic syndrome
- Bowel obstruction
- Bile leak
Myelofibrosis: FBE and film
Anaemia
Variable WCC and platelet counts
Film:
Teardrops
leukoerythroblastic profile
Circulating nucleated red blood cells
