Abdomen 2

 

Home
Up
How to use ACES forPACES
Cover
Contents
Extracts
Appendix
Guidelines for MRCP PACES
Common Cases in MRCP PACES
Buy ACES for PACES
EMQS
Forum
Useful Links
Best of Five

amazon astore

ydr

Medical Revision

 

Google
Web ydr.org.uk
acesforpaces.com medicalrevision.org

Description

The patient was an elderly man who was lying comfortably in bed. He was tall but underweight.

He had no icterus, he was not pale there was no parotid enlargement.

On examination of his hands there was Dupuytren’s contractures in his left hand and there was palmar erythema.

He had no spider naevi but there was paucity of body hair and he had gynaecomastia.

His abdomen was not distended. There were prominent veins over the anterior abdominal wall; the flow of blood within these vessels was away from the umbilicus. His liver was not enlarged, the spleen was palpable 3 fingerbreadths below the costal margin it was firm. No other lumps were palpable; there was no free fluid within the peritoneal cavity. A venous hum was heard between the umbilicus and the right costal margin.

Analysis

         The fact that the patient is underweight would indicate chronic illness (Page 290,291)

ª       Dupuytren’s contracture would point to alcohol being implicated in aetiology (Page 298, 306)

¨        Palmar erythema would suggest hepatocellular dysfunction (Page 298, 150)

§        Paucity of body hair and gynaecomastia too reflect hepatocellular failure (Page 299, 300, 352)

         Distended veins over the anterior abdominal wall in the context of features of hepatocellular failure suggest the patient has portal hypertension (Page 302)

ª       Splenomegaly has many causes (Page 304, 389). However, in the context of features of hepatocellular failure and portal hypertension, the most likely cause is portal hypertension.

¨        The venous hum confirms that the patient has portal hypertension (Page 304, 305)

Diagnosis

§        The patient has features of portal hypertension and hepatocellular failure. Clinically the patient has cirrhosis of the liver. (Page 305)

         This has many causes

ª       Clinically the only pointer is Dupuytren’s contracture

¨        However, this is inadequate to confidently state that this is the aetiology.

§        The patient will need further investigation in the form of a liver screen, imaging, and if all else fails this patient may require a liver biopsy.

[Back] [Up] [Next]

ACES for PACES is available on Amazon. It is also available on many other internet bookshops.

The link below will take you to amazon .co.uk

If you wish to purchase  ACES for PACES from your local bookshop, please ask them  to order it from wholesalers such as Bertrams or Gardners if they do not have it in stock

Search onother websites and from wholesalers using the ISBN number:

1905006047

 

 [Up]