Abdominal conditions signs

Chronic liver disease

  • Clubbing
  • Leukonychia
  • Palmar erythema
  • Dupuytren’s contracture
  • Jaundice
  • Spider naevi
  • Gynaecomastia
  • Loss of axillary hair
  • Distended abdominal wall veins/‘caput medusae’ (portal hypertension)
  • Hepatomegaly (but liver is often small in cirrhosis) 
  • Splenomegaly (portal hypertension)
  • Ascites

Advanced signs

Signs of aetiology: Afro-Caribbean (sarcoid), slate-grey pigmentation/capillary glucose monitoring marks (haemochromatosis), track marks/tattoos(hepatitis C), xanthelasma (PBC), goitre/middle-aged female (autoimmune), emphysema (α1-antitrypsin deficiency)
Signs of decompensation: asterixis and confusion (encephalopathy), jaundice, ascites

Transplanted kidney

  • Old AV fistula 
  • Rutherford-Morrison scar (usually RIF)
  • Smooth mass underlying scar (transplanted kidney)

Advanced signs

Signs of aetiology: fingertip capillary glucose monitoring marks (diabetes), hearing aid(Alport syndrome), collapsed nasal bridge (granulomatosis with polyangiitis), butterfly rash (SLE), sternotomy (renovascular disease), flank masses (PKD)
Functionality: asterixis/confusion (uraemic encephalopathy), excoriations (uraemia), active marks in AV fistula, pale conjunctiva(anaemia), fluid retention 
Previous renal replacement therapy: AV fistula, central line and peritoneal dialysis scars
Complications of immunosuppression: tremor (calcineurin inhibitor), cushingoid/bruising (steroids), skin lesions/excisions (immunosuppression)

Hepatosplenomegaly

  • Hepatomegaly/splenomegaly/both

Advanced signs

Signs of hepatomegaly aetiology: signs of chronic liver disease, lymphadenopathy (malignancy/lymphoma), peripheral oedema/raised JVP (right ventricular failure)
Signs of splenomegaly aetiology:
 hand deformity (RA/Felty’s syndrome), signs of chronic liver disease, pale conjunctiva (leukaemia/ myeloproliferative/haemolytic anaemia), lymphadenopathy (lymphoma)

Polycystic kidneys

  • AV fistula (if undergone dialysis)
  • Hypertension
  • Pale conjunctiva (anaemia)
  • Flank scar (if either kidney has been removed)
  • Bilateral ballotable flank masses
  • Hepatomegaly (hepatic cysts)

Liver transplant

  • Signs of chronic liver disease (but most resolve)
  • Mercedes Benz modification scar      

Advanced signs

Signs of aetiology: Afro-Caribbean (sarcoid), slate-grey pigmentation/capillary glucose monitoring marks (haemochromatosis), track marks/tattoos (hepatitis C), xanthelasma(PBC), goitre/middle-aged female (autoimmune), emphysema (α1-antitrypsin deficiency
Complications of immunosuppression: tremor (calcineurin inhibitor), cushingoid/bruising (steroids), skin lesions/excisions (immunosuppression)

Combined kidney-pancreas transplant

  • LIF scar (renal graft)
  • RIF scar (pancreas graft)
  • Smooth mass underlying LIF scar (transplanted kidney)

Advanced signs

Signs of diabetic complications: visual aids (retinopathy), Charcot joints, toe ulcers/amputations, neuropathy
Renal graft functionality: asterixis/confusion (uraemic encephalopathy), excoriations (uraemia), active marks in AV fistula, pale conjunctiva(anaemia), fluid retention
Pancreas graft functionality: fingertip capillary glucose monitoring marks, insulin injection marks
Previous renal replacement therapy: AV fistula, central line and peritoneal dialysis scars (but transplant may have been done pre-emptively)
Complications of immunosuppression: tremor (calcineurin inhibitor), cushingoid/bruising (steroids), skin lesions/excisions (immunosuppression)

Polycythaemia rubra vera

  • Dusky cyanosis
  • Hypertension
  • Facial plethora
  • Splenomegaly

Hereditary spherocytosis

  • Pale conjunctiva
  • Mild jaundice
  • Splenomegaly

Primary biliary cholangitis

  • Middle-aged female
  • Jaundice
  • Skin hyperpigmentation
  • Excoriations
  • Xanthelasma
  • Hepatomegaly

Advanced signs

Signs of complications: signs of chronic liver disease

Try some questions!

Please list some extra-renal signs of polycystic kidney disease

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Which conditions can cause secondary polycythaemia?

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A middle-aged female presents to you with jaundice and hepatomegaly, which conditions would you include in your differential diagnosis?

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What are the main ways to prevent graft rejection after renal transplantation?

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And some stations…

  1. Chronic liver disease
  2. Renal transplant
  3. Hepatosplenomegaly
  4. Find more here!
  1. Thank you for the comprehensive notes on this website. The information you’ve provided has made studying so much easier, and I’m truly grateful. Thanks!

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