EMQs in Clinical Medicine.pdf - Peshawar Medical College

The abdomen and surgery – revision boxes 193
Box 3 Signs of chronic liver disease
Signs
Clubbing
Flapping tremor
Dupuytren’s contracture
Palmar erythema*
Gynaecomastia
Spider naevi*
Splenomegaly*
Testicular atrophy
Ascites*
Encephalopathy*
Signs
Condition
Chronic liver disease associated with:
Early onset emphysema 1 -Antitrypsin deficiency [57]
Pigmentation, diabetes Haemochromatosis [57]
Dysarthria, dyskinesia, dementia, Wilson’s disease [57]
Kayser–Fleischer ring
* Denotes signs that also occur in acute liver disease
The two conditions primary biliary cirrhosis and primary sclerosing cholangitis are
frequently confused with each other and commonly crop up in EMQs (Box 4).
Box 4 Differentiation of hepatobiliary conditions
Condition
Associated problems
Primary biliary cirrhosis [59] Middle-aged woman presents with:
Pruritus, jaundice, pigmentation
Anti-mitochondrial antibody (AMA)
positive
Associated with: rheumatoid arthritis
Sjögren’s syndrome
thyroid disease
keratoconjunctivitis sicca
renal tubular acidosis
membranous glomerulonephritis
Primary sclerosing cholangitis [59] Usually middle-aged man, presents with:
Pruritus, jaundice, abdominal pain
↑ ALP (alkaline phosphatase), AMA
negative
Associated with inflammatory bowel
disease (especially ulcerative colitis)