Renal
General
- Mental state
- Hyperventilation, resp effort
- Cushingoid
- Scars
- Hydration status
- Visible access
Hands
- Nails - terry nails, brown lines
- Asterixis
- Neuropathy
Arms
- Bruising
- Fistulas, access
- Pruritis, scratch marks, pigmentation
- Urea forst
- BP
Face
- Eyes - anaemia, jaundice, band keratopathy
- Mouth - mucous membranes, fetor
- Rash
- Hair loss (Cx medications)
Chest
- Heart sounds - urea pericarditis, CCF
- Lungs - infection, overload
Abdo
- Scars, PD access
- Liver, spleen - megaly
- Palpable kidneys, transplant kidneys
- Ascites
- Renal bruits
Legs
- Oedema
- Bruising, pigmentation
- Pruritis
- Gout
- Neuropathy
Urine analysis
Fundoscopy (HTN, DM)
Cause of abdominal distension
Fs Fat Foetus Fluid Flatus from bowel obstruction Faeces filthy big tumours
Spleen vs Kidney
1) spleen has no palpable upper border (kidney do have space between costal margin)
2) spleen has notch - maybe palpable
3) spleen move inferomedially cf to kidney only goes inferior w inspiration
4) spleen usually not ballottable unless gross ascites present
5) percussion dull over spleen, resonant over kidney (kidney is posterior with overlying gas-filled bowel)
6) might hear friction rub over spleen never with kidney
Firm and irregular liver
Cirrhosis HCC Met disease Hydatid disease Granuloma eg sarcoid Amyloid Cysts
Tender liver
Hepatitis Rapid liver enlargement eg right heart failure, Budd Chiari HCC Hepatic abscess Biliary obstruction/ cholangitis
Hepatomegaly
Large
- mets
- alcoholic liver
- myeloproliferative disease
- right heart failure
- HCC
Medium
- haemochromatosis
- haematological
- fatty liver
- infiltration eg amyloid
Mild
- hepatitis
- biliary obstruction
- hydatic disease
- HIV infection
Caput medusae vs IVC obstruction
Caput medusae - towards legs
IVC obstruction- towards heart
Pulsatile liver
Tricuspid regurg
HCC
Vascular abnormalities
Hepatosplenomegaly
CHII CAT Chronic liver w fatty filtration Haematological eg myeloproliferative, lymphoma Infection eg hepatitis, EBV, CMV Infiltration eg amyloid, sarcoid Connective tissue disease eg lupus Acromegaly Thyrotoxicosis
Ascites
Serum ascites to albumin gradient
High gradient >/= 11 (Portal hypertension) Cirrhosis w portal HTN Alcoholic hepatitis Budd chiari syndrome Fulminant hepatic failure Congestive heart failure Myxoedema
Low gradient <11 peritoneal Peritoneal carcinomatosis Tuberculosis Pancreatic ascites Nephrotic syndrome Bowel obstruction
Splenomegaly
Massive
- Haem esp CML, myelofibrosis
- Malaria
Moderate
- portal HTN
- lymphoma/ leukaemia
- thalassaemia
- storage disease
Small
- other myeloproliferative eg PCV
- haemolytic anaemia
- infection
- connective tissue disease
- infiltration
Lymphadenopathy
Generalised
- lymphoma/ leukaemia
- infection
- Connective tissue
- Infiltration
- Drugs
Localised
- Local acute or chronic infection
- Mets
- Lymphoma esp Hodgkin disease
Pancytopaenia
Aplastic anaemia Bone marrow failure from Marrow infiltration eg leukaemia Hypersplenism Significant nutritional def eg folate PNH
Polycythaemia
Idiopathic polycythaemia rubra vera Secondary Increased EPO - renal disease - HCC - Cushing syndrome Hypoxic state - chronic lung - sleep apnoea - high altitude - cyanotic congenital heart - abnormal Hb
