"Abdomen"
MRCP-PACES 30th November 2005
Station 1:
Abdomen:
During periphery examination, I noted an AVF. So, that gave me a clue this was a renal patient and the case probably a APCKD or transplanted kidney. There was no stigmata of CLD. Abdominal examination reviewed a RIF mass with an overlying mass, a RHC mass with bilateral balottable kidneys. So, confidently, I said, "This patient has a right transplanted kidney. He has ESRF secondary to APCKD". Examiner asked me, "What do you think the RHC mass is?". I wasn't sure. I "hentam", most probably a right polycystic kidney. Examiner wasn't satisfy and asked "what else?". I said, it could be a liver. Why? Because, this patient was hemodialysis-dependent previously, so he could have contracted infective hepatitis due to Hep B or C. "What else?". By that time, the bell rang. Didn't get into the management part.
Comment:
In retrospectively, I thought, that could be a polycystic liver!!
Outcome: 4/2
Labels: Abdomen
posted by Cytusm @ 3/03/2006 03:58:00 PM
2 Comments:
I got very similar case in Dec 2006 at UK centre. Patient had APKD with AVF, right renal transplant and a liver transplant. Examiners asked me to put my findings into one diagnosis. I said APKD with Renal and, liver transplant for cysts in liver, but examiners were asking me about other differentials which I couldnt think of... I got 3/4
I think they werw looking for lopcystic kidney disease with liver involvement which is more common in childhood AR-PKD but can be seen in adult AD-PKD.
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