AbdominalClinical examination
·10 min read

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

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

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

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, 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

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!
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Renal examination
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Abdominal Examination
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