Hepatorenal syndrome physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sunny Kumar MD [2]

Overview

Hepatorenal syndrome (HRS) 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..^[1]^[2]^[3]

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

Neurologic

Abnormal reflexes
Confusion on neurologic testing

Cariovascular:

Hyperdynamic circulation
Reduced systemic vascular resistance
Low mean arterial pressure
Low jugular venous pressure
Tachycardia
Bounding pulse
Wide pulse pressure

References

↑ Heemann U, Füeßl HS, Renders L (2015). “[The hepatorenal syndrome]”. Dtsch Med Wochenschr. 140 (20): 1520–3. doi:10.1055/s-0041-105807. PMID 26445256.
↑ Pandey CK, Karna ST, Singh A, Pandey VK, Tandon M, Saluja V (2014). “Hepatorenal syndrome: a decade later”. J Assoc Physicians India. 62 (8): 696–702. PMID 25856938.
↑ Hrabovský V, Mendlová A, Vavříčková T (2015). “[Hepatorenal syndrome – pathophysiology, diagnosis and treatment]”. Vnitr Lek. 61 (7–8): 649–54. PMID 26375691.

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[pmid26445256-1] Heemann U, Füeßl HS, Renders L (2015). “[The hepatorenal syndrome]”. Dtsch Med Wochenschr. 140 (20): 1520–3. doi:10.1055/s-0041-105807. PMID 26445256.

[pmid25856938-2] Pandey CK, Karna ST, Singh A, Pandey VK, Tandon M, Saluja V (2014). “Hepatorenal syndrome: a decade later”. J Assoc Physicians India. 62 (8): 696–702. PMID 25856938.

[pmid26375691-3] Hrabovský V, Mendlová A, Vavříčková T (2015). “[Hepatorenal syndrome – pathophysiology, diagnosis and treatment]”. Vnitr Lek. 61 (7–8): 649–54. PMID 26375691.

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