abdominal system

1) Causes of uniform distention of abdomen?

A) Fetus, Flatus, Fat, Fluid, Feces, Fibroid, Full bladder

2) Difference between obesity and ascitis.

A)
Obesity Ascitis
Umbilicus inverted. Umbilicus everted
Shifting dullness absent Shifting dullness present
Fluid thrill absent Fluid thrill present
Upper segment to lower Upper segment to lower
segment ratio is normal segment ratio is increased

3) Features of IVC obstruction at various level.

A) 1. Obstruction at level of azygos vein:a) above: no
collaterals
b) below: increased collaterals.
 2. At the level of hepatic vein: a) above: budd chiari
syndrome, absent hepato jugular reflex and ascitis
3) At the level of renal vein:a) Above: proteinuria/
haematuria, ascitis/ pedal edema.
b) below: only bilateral pedel edema.

4) Normal liver span.

A) 13 – 15 cms in the right mid clavicular line in normal adult.

5) causes of tender hepatomegaly.

A) Acute viral hepatitis, CCF, Carcinoma of liver, Budd chiari
syndrome Hepatic abscess.

6) Causes for pulsatile liver.

A) Hepatoma, Haemangioma of the liver, Aortic incompetence,
tricuspid incompetence(systolic), tricuspid stenosis(pre
systolic), AV malformation.

7) Causes for spleanomegaly.

A) Mild(< 5 cms): CCF, acute malaria, Typhoid, Infective
endocarditis ,Sepsis, SLE, Rheumatoid arthritis, Viral hepatitis,
Thalssemia minor, HIV.
 Moderate: 5-8 cms): Cirrhosis of liver, lymphoma, leukemia,
infectious mononucleosis, hemolytic anemia, splenic abscess,
amyloidosis, hemochromatosis, polycythemia vera.
Massive:(>8 cms) :Chronic malaria, chronic kala azar, CML,
Extra hepatic portal vein obstruction, Tallesemia major,
Myelofibrosis, Hairy cell leukemia, gauchers, niemann pick
disease, Sarcoidosis.

8) Difference between spleen and left kidney.

A)

SPLEEN LEFT KIDNEY

a) Enlarges downwards, a) Enlarges towards left iliac

forwards and towards the fossa and has restricted
right iliac fossa and moves movement with respiration.
well with respiration.
b) Notch felt b) No notch felt
c) Sharp margin c) Rounded margin
d) Not ballotable or bi d) Bimanually palpable and
manually palpable ballotable
e) Fingers cannot be e) Fingers can be insinuated
insinuated b/n left costal f) Band of colonic resonance
margin and enlarged Is present on percussion.
 spleen g) Tendancy to bulge into the
f) Percussion note is always loin
dull no colonic band of
resonance
g) Tendency to bulge forward
h) Renal angle is non tender h) Renal angle may me tender

9) Methods of palpation of liver and spleen.

A) Liver:a) classical b) hooking method c) dipping method.
Spleen:a) classical b) right lateral position c) hooking
d) dipping

10) Percussion of spleen.

A) Castell’s method
Nixon’s method

11) Baumbagarden's sign.

A) Venous hum between xiphisternum and umbilicus or around
 umbilicus. Heard in portal hypertention.

12) Precipitating factors for hepatic encephalopathy.

A) GI bleed, Increased dietary protein , Large volume
paracentesis, hopokalemia, hyponatremia, vomiting,
diarrhea, overzealous use of diuretics, acute infections,
Uremia, sedatives, constipation, viral hepatitis, surgical
shunts.

13) Causes and complications of cirrhosis of liver

A) causes: Alcohol, Biliary cirrhosis: primary/ secondary,
Cryptogenic, post necrotic or post viral, cardiac Cirrhosis,
Metabolic:Wilson’s, haemochromatosis, type 4 glycogenosis,
alpha 1 anti trypsin deficiency, galactossemia, DRUGS:
Methotrexate, amiodarone, methyl dopa, halothane.
Miscellaneous:Inian child hood cirrhosis, budd chiari, auto
immune hepatitis, non alcoholic steato hepatitis.
COMPLICATIONS OF CIRRHOSIS: Portal hypertention,
hepatocellular failure and hepatic encephalopathy, ascitis, SBP,
Hepatorenal syndrome, Acute and chronic pancreatitis,
Cholecystitis and pigment stones, peptic ulcer, portal vein
thrombosis, HCC, hepato pulmonary syndrome.
14) Mechanism of ascitis in cirrhosis of liver.
1) reduced oncotic pressure due to hypo proteinemia.
2) increased capillary permeability. Ex: inflammation and
peritonitis.
3)increased hydrostatic pressure.Ex: CCF
4)increased hepatic lymphatics.Ex: lymphatic obstruction.
5)inability to inactivate ADH.
6) NEWER THEORIES:a) underfilling theory: loss of fluid into
peritoneum activation of RAAS Renal retention of sodium
and water. This causes ascitis.
a) overflow theory: Portal hypertention increased NO
secretion vasodilation Decreased arterial blood volume
stimulation of RAAS increased sympathetic activity and
increased sodium and water retention and overflow of fluid and
ascitis

15) Mechanism of clubbing in liver disease

A) Due to increased pulmonary arterio venous shunt causes
hypoxia and results in clubbing
Hyper estrogenemia also contributes.
16) What is chronic hepatitis? what are its types?
A) It is defined as sustained chronic inflammatory reaction in
the liver lasting for more than 6 months.
TYPES: chronic active
chronic persistent,
Chronic lobular hepatitis

17) What are the types of hepatitis?

Acute: a) All viral hepatitis.
Chronic:a) active- due to hepatitis virus B and C.
- Auto immune.
b) persistant
c)lobular.

18) What are the complications of hepatitis?

A) Fulminant hepatic failure, relapsing hepatitis, cholestatic
hepatitis, post hepatitis syndrome, renal failure, chronic
hepatitis, cirrhosis, hepato cellular carcinoma, transverse
myelitis.

19) Uses of lactose in hepatic encephalopathy.

A) Metabolism of lactulose by colonic bacteria results in an
acid PH in the intestine, which favours conversion of ammonia
to ammonium which is poorly absorbed.
Lactulose diminishes ammonia production by its direct effect
on bacterial metabolism.
It acts as a osmotic purgative.

20) What is congestive gastropathy?

A) Long standing portal hypertention causes chronic gastric
congestion recognisable at endoscopy as multiple area of
punctuate erythema.

21) Alcoholic liver disease.

A) Fatty liver
Alcoholic hepatitis
Cirrhosis.

22) Abdominal girth measurement and its importance.

A) measured at the level of lower costal margin.
IMPORTANCE: To assess prognosis in acute abdomen,
peritonitis, paralytic illeus and obstruction of bowel, ascitis.
23) Difference between midline mass and ascitis.
A)
Midline mass Ascitis
1. Upper segment :lower 1. Upper segment : lower
segment ratio decreases segment ratio increases
2. Shifting dullness absent 2. Shifting dullness present
3. Fluid thrill absent 3. Fluid thrill present
4. On percussion, convexity 4. On percussion, convexity
is upwards is downwards
5. Midline dull, flanks 5. Midline is tympanic,
tympanic. flanks are dull.

24) Causes of portal hypertention?

A) PREHEPATIC-extrahepatic portal vein thrombosis, splenic
vein thrombosis
HEPATIC- a) presinusoidal- schistosomiasis, primary biliary
cirrhosis, non cirrhotic portal fibrosis
b) sinusoidal- cirrhosis,
c) postsinusoidal- veno occlusive disease.
POSTHEPATIC- Budd-chiari syndrome , CCF, constrictive
pericarditis
25) Non cirrhotic portal hypertention.
A) It is an idiopathic disease characterized by portal
hypertension & splenomegaly but without features of liver cell
failure. Ascitis is unusual. Etiology may be due to idiopathic
portal hypertension, schistosomiasis, congenital hepatic
fibrosis, chronic arsenic ingestion.

26) Fulminant hepatitis.

A) Hepatic encephalopathy with mental changes from
confusion to stupor and coma with sudden severe impairment of
hepatic function occurring within 8 weeks without pre existing
liver disease.

27) Difference between hepatitisA, hepatitis B, hepatitis C,

hepatitis D and hepatitis E
Features HEP A HEP B HEP C HEP E
Incubation 15-45 days 50-150 15 – 150 40-50 days
period days days
Onset acute insedious insedious acute
Route of Feco-oral parenteral parenteral Feco-oral
transmissio
n
Chronicity none 5-10% 50-70% none
Prognosis good worse moderate good
Prophylaxis Immune Vaccine & none none
serum Ig
globulin
Carrier none 1-30% 1% none
state
NOTE : HepatitiS-D is a defective RNA virus having no
independent existence. It requires HepatitisB virus for
replication and expression. It can cause coinfection or
superinfection with HepB virus.

28) Hypersplenism.
A) It is splenic hyperactivity with increased blood cell
destruction.
Diagnostic criteria – splenomegaly, pancytopenia, hypercellular
bone marrow, reversibility after splenectomy.
Causes- primary
Secondary-connective tissue disorders, lymphomas,
myeloproliferative disorders, etc.

29) Tropical splenomegaly.

A) Patient coming from hyperendemic area with an
exaggerated immune response to malaria. Adults have high
malarial antibody titres with low parasitemia. There is massive
splenomegaly.

30) Causes for acute and chronic parenchymal liver

disease?
A) Etiology for acute-
a)Viral- Hep A,B,C,D,E
b)Non viral – Leptospira, toxoplasmosis
c)Drugs- lead, mercury, methotrexate
d)Poisons- arsenic, heavy metal
e) Radiation
f) Ischemic
B) Etiology for chronic
a)Viral- Hep B,C,D.
b)Non- viral- alcohol, Wilsons disease, haemochromatosis,
haemosiderosis, drugs and autoimmune disease, etc..
31) Extra intestinal manifestation of inflammtory bowel
disease.
A) eye: iritis, uveitis, episcleritis, conjunctivitis
Hepatobiliary:fatty liver, gall stones, peri cholangitis,
sclerosing cholangitis, bile duct carcinoma, cirrhosis and
amyloidosis.
Musculoskeletal : Ankylosing spondylitis, sacro ileitis
Skin and mucous membrane : Erythema nodosum, pyoderma
gangrenosum, clubbing.
Hematological :Autoimmune hemolytic anemia, venous
thrombosis.
Renal : calculous disease, amyloidosis, pyelonephritis.

32) Pemberton's sign.

A)Ask the patient to raise both arms above the shoulder. There
will be facial congestion and respiratory distress and dilatation
of the great veins. It occurs in patients with retrosternal goiter
due to obstruction of great vessels at the thoracic inlet.

33) Causes for rigidity of abdomen.

A) Intraabdominal abscess, Peritonitis, perforation of bowel,
acute appendicitis, acute cholecystitis, acute pancreatitis,
salpingitis, intestinal strangulation, superior mesenteric artery
thrombosis, ruptured ectopic, twisted ovarian cyst.

34) Thumping sign.

A) Strike with the right fist over the lower right ribcage.
Patient feels pain or tenderness. Indicates an inflamed liver.

35) Murfy's punch.

A) Costovertebral angle tenderness. Elicited by percussing the
area overlying the kidney at the back at the costovertebral
junction. Positive in perinephric abscess, pyelonephritis and
renal stones.

36) Hepatic facies.

A) Shrunken eyes, hollowed temporal fossa, pinched up nose
with malar prominence, parched lips, muddy complexion of
skin, shallow and dry face, icteric tinge of conjunctiva, seen in
chronic liver disease.

37) Rebound phenomenon.

A) First give firm pressure over the abdomen and now,
suddenly take off the hands. Patient complains of severe pain in
the abdomen if the sign is positive. Seen in peritonitis

38) Succusion splash.

A) This is elicited by shaking the patient from side to side and
simultaneously listening to the splashing sound by placing the
diaphragm of the stethoscope over the distended area in the
epigastrium. Seen in gastric outlet obstruction.

39) Trousseau's sign.

A) Migratory thrombophlebitis seen in carcinoma of pancreas.
It is a paraneoplastic syndrome.

40) Stigmata of alcoholic cirrhosis.

A) parotid enlargement, gynacomastia, spider naevi,
Dupuytrens contracture.

41) Causes of pain abdomen in cirrhosis.

A) a) SBP b) mesenteric vessel occlusion c) hepatoma

42) Caput medusae.

A) Dilated, tortuous veins seen around the umbilicus due to
portosystemic shunt. Seen in portal hypertension.
43) Gynaecomastia.
A) In males, the nipple areola more than 4-5cms, nodular,
tender.
Causes- idiopathic, physiological, drug induced (cimetidine,
digoxin, cyproterone acetate, spironolactone, ) ,hypogonadism,
androgen resistance syndrome, estrogen excess seen in liver
failure, estrogen secreting tumours and hcg secreting tumours.