Liver Transplant
- Boot Camp
- Aug 9, 2023
- 0 min read
Things to consider
Residual Signs of Chronic Liver Disease
Previous conditions of chronic liver disease may manifest as lingering signs in the patient's physical state.
Presence of Scars
The standard 'Mercedes Benz' type incision scar, indicative of a liver transplant, is often present. Additional scars related to intensive care procedures such as tracheostomy, central line insertion, and abdominal drains might also be visible.
Liver Palpability and Size
In a healthy liver transplant, the 'new' liver, replacing the old one in the same location, is typically not palpable in the right upper quadrant. Hepatomegaly or enlarged liver is unusual, but the edge of the liver may occasionally be felt.
Possible Renal Allograft
A mass in the left loin may suggest a concurrently transplanted renal allograft, a scenario commonly associated with combined liver and kidney failure following a paracetamol overdose.
Indicators of Transplant Necessity
Specific clinical signs could hint at the reasons for liver transplantation. For instance, slate-grey pigmentation may point to Haemochromatosis, while tattoos and needle marks could indicate Hepatitis B or C.
Evidence of Immunosuppressive Medication
Signs of immunosuppressive medication usage may also be observed. Gum hypertrophy and hypertension can suggest Ciclosporin use, while a Cushingoid appearance, thin skin, and ecchymoses might indicate Steroid usage.
Important Reminders
Interpreting Abdominal Scars
Exercise caution not to be confused by an unusual abdominal scar. The 'Mercedes Benz' scar typically denotes a major upper abdominal operation. Differential diagnoses should include liver transplant, radical gastrectomy, Whipple's procedure, and bilateral adrenalectomies.
Liver Size and Palpability Post-Transplant
It's essential to understand that a liver transplant is usually not palpable and the liver is generally not enlarged post-transplant. If a mass is observed in the left loin, it could likely be the renal allograft from a simultaneous kidney-liver transplant.