Table of Contents
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
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/confusion (encephalopathy), jaundice, ascites
Transplanted kidney
- Old AV fistula
- Rutherford-Morrison scar (usually RIF)
- Smooth mass underlying scar (transplanted kidney)
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
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
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)
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)
Polycythemia 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
Signs of complications: signs of chronic liver disease