Table of Contents Chronic liver diseaseTransplanted kidney Hepatosplenomegaly Polycystic kidneys Liver transplant Combined kidney-pancreas transplant Polycythaemia rubra veraHereditary spherocytosis Primary biliary cholangitisTry some questions!And some stations… 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 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 Palmar erythemaDupuytren’s contractureClubbingIcteric scleraPale conjunctivaAscitesAscites, distended abdominal veins, spider naevi Transplanted kidney Old AV fistula Rutherford-Morrison scar (usually RIF) Smooth mass underlying scar (transplanted kidney) Advanced signs 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 scarsComplications of immunosuppression: tremor (calcineurin inhibitor), cushingoid/bruising (steroids), skin lesions/excisions (immunosuppression) Hepatosplenomegaly Hepatomegaly/splenomegaly/both Advanced signs 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 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 Advanced signs Signs of diabetic complications: visual aids (retinopathy), Charcot joints, toe ulcers/amputations, neuropathyRenal graft functionality: asterixis/confusion (uraemic encephalopathy), excoriations (uraemia), active marks in AV fistula, pale conjunctiva(anaemia), fluid retentionPancreas graft functionality: fingertip capillary glucose monitoring marks, insulin injection marksPrevious 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 Advanced signs Signs of complications: signs of chronic liver disease Try some questions! Please list some extra-renal signs of polycystic kidney disease Oops! This section is restricted to members. Which conditions can cause secondary polycythaemia? Oops! This section is restricted to members. A middle-aged female presents to you with jaundice and hepatomegaly, which conditions would you include in your differential diagnosis? Oops! This section is restricted to members. What are the main ways to prevent graft rejection after renal transplantation? Oops! This section is restricted to members. And some stations… Chronic liver disease Renal transplant Hepatosplenomegaly Find more here!
