Abdomen and liver case with Question & answers
Chronic decompensated parenchymal liver disease - cirrhosis with portal hypertension probably of alcoholic etiology with no ascites with no features of hepatic encephalopathy and coagulopathy
To rule out malignancy
Abdomen and liver case presentations with Question & answers
1. Ques. 1 :
The clinical significance of Spider Angiomatoes
and other condition that you can see Spider
Angiomatoes.
2. Ans :
Correlate C severity of Liver disease.
Pregnancy & Malnutrition
Cause : ↑ oestradial & free Testoster one.
3. Ques. 2 :
What are the Nail changes that occur in
cirrohosis.
4. Ans :
1. MUEHRCKE’S NAIL
Paired Horizontal white bands separated by
normal colour.
2. Terry’s Nail
Proximal 2/3 of Nail plate appears white,
Distal 1/3 is red.
Probable cause : ↓ serum Albumen
5. Ques. 3 :
Caput Medusae when do you get and what are
the veins taking part in the shunt.
6. Ans :
Cirrhosis of liver with portal hypertension.
Portal venous system may be shunted through
the periumbliul veins into the umblical vein then
to the abdominal vein causing them to become
prominent.
8. Ans :
Due to fatty infiltration, fibrosis & edema :
Not due to ↑ function of gland.
9. Ques. 5 :
What vaccine in chromic liver disease is indicated?
10. Ans :
According to ACIP :
Hepatitis ‘A‘ Vaccine :
Immun Genicity : 95% of liver disease shows sero
conversion compared to healthy – 98%
Safety :
Well tolerated no special precaution needed
Dose : Two Doses.
11. Hepatitis ‘B’ Vaccine :
Recombinant HBV Vaccine
Dose : 0, 1 & 2 months
Serco conversion :
After 1st dose
Safety 94% :
No adverse events
Hepatitis ‘C’ vaccine :
No prophylactic or Therapeutic vaccine
Pneumococcal vaccine
Influenza vaccine
Diphtheria and tetanus
Meningococcal and Homophilous
influenza vaccine
12. Ques. 6:
Cirrotosis of liver C mild portal Hypertension,
Hepatitis ‘B’ carrier and Hepatitis ‘C’ desire to
have pregnancy - what advise you will give ?
13. Ans :
1. Do upper endoscopy to look for varices before pregnancy.
If present, pregnancy is ↑ High risk for Hemorrhage.
Prophylaxis with B Blocker may be continued during
pregnancy New Borns should be monitored for Hypoglycemic
and Bradycardia .
2. spontaneous rupture of spleenic artery may occur during
pregnancy.
2. Reactivation of the virus and exacerbation of the disease during
or after gestation are uncommon. Placenta Forms an excellent
barrier against this virus. Major problem during delivery
exposure to maternal blood in the birth caned.
3. Hepatic ‘C’ uneventful pregnancy
14. Ques. 7 :
What is the mechanism for vasodilatation in PHT
15. Ans :
↑level of circulating Vaso Dilators.
Nitric Oxide is the primary mediators.
vasodilatations in cirrohosis due to No synthase
activity ↑
19. Ans :
• New Tech to measure the Borders of liver
• Place the stethoscope on the xiphoid
process Scratch from below the Rt. nipple
/ Breast you clearly here the liver
borders.
• First sound is when the liver appears &
when the sound disappears it is the end
of the liver.
21. Ans :
Murphy’s Sign (Cholycystitis)
Rebound Tenderness
Psoas Sign
Obturator Sign
Rovsing Sign (Pain in the Rt. Iliac Fossa on Palpation
of Lt. Side of Abdomen) (Referred Tenderness)
Carnett’s Sign (Pain when Tensing the ABD.
Wall Mass)
Pata Fros Sign (Pain when the pt is asked to Cough)