Hepatorenal syndrome physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sunny Kumar MD [2]
Overview
Hepatorenal syndromeHRS does not have specific clinical findings.However patient has reflect the underlying advanced liver disease, renal impairment, and circulatory abnormalities present.
Physical Examination
Patients with type 1 HRS have worse clinical picture than patients with type 2 HRS.
constitutional disturbances:
- Weakness
- Fatigue
- Anorexia
- Poor nutritional status
Skin
Abdomen
- Abdominal distension
- Shifting dullness: Dull sound in the belly area when tapped with the tips of the fingers - indicates presence of fluid
- Hepatomegaly
- Stigmata of portal hypertension{ gastroesophageal varices, caput medusa, hepatic encephalopathy }
- Gynaecomastia
- Spider naevi
Genitals
- Small testicles
- Oliguria
Extremities
- Pedal edema
- Involuntary jerky movements
- Finger clubbing
- Palmar erythema
Neurologic
- Abnormal reflexes
- Confusion on neurologic testing
Cariovascular:
- Hyperdynamic circulation
- Reduced systemic vascular resistance
- Low MAP,
- Low jugular venous pressure
- Tachycardia
- Bounding pulse
- Wide pulse pressure