Cirrhosis physical examination

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

Overview

Patients with cirrhosis usually present with signs of jaundice, palmar erythema, spider angiomata, gynaecomastia and alteration of mental status arising due to complications of cirrhosis. Abdominal examination may show signs of abdominal distension, caput medusae, splenomegaly and flank dullness on percussion. Other findings on examination include nail changes, presence of Clubbing, dupuytren's contracture(flexion deformities of the fingers) and Asterixis in cases with hepatic encephalopathy.

Physical Examination

Appearance of the patient

Skin

HEENT

Liver Cirhhosis
Source: Wikimedia commons

Abdomen

  • Palpation:
    • Fluid wave
    • Hepatomegaly may be present in initial stages. The liver may also be normal or shrunken.
    • Spleenomegaly may be present in patients with cirrhosis from nonalcoholic etiologies, due to portal hypertension
  • Percussion:
    •  Flank dullness may be present due to ascites (needs approximately 1500ml for detection)

Genitourinary

Neuromuscular

Extremities

Chest findings 

Other findings

References

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  2. "File:Kawasaki symptoms D.jpg - Wikimedia Commons". 
  3. Sridhar MS, Rangaraju A, Anbarasu K, Reddy SP, Daga S, Jayalakshmi S, Shaik B (2017). "Evaluation of Kayser-Fleischer ring in Wilson disease by anterior segment optical coherence tomography". Indian J Ophthalmol. 65 (5): 354–357. PMC 5565897Freely accessible. PMID 28573989. doi:10.4103/ijo.IJO_400_16. 
  4. Kim, SH; Keum, B; Kim, ES; Jeen, YT; Chun, HJ (2014). "Hepatobiliary and Pancreatic: Caput medusae". Journal of Gastroenterology and Hepatology. 29 (12): 1952–1952. ISSN 0815-9319. doi:10.1111/jgh.12802. 
  5. Chandail VS, Jamwal V (2013). "Caput medusae". J Assoc Physicians India. 61 (8): 564. PMID 24818343. 
  6. , <"https://commons.wikimedia.org/wiki/File%3AHepaticfailure.jpg">via Wikimedia Commons
  7. MUEHRCKE RC (1956). "The finger-nails in chronic hypoalbuminaemia; a new physical sign". Br Med J. 1 (4979): 1327–8. PMC 1980060Freely accessible. PMID 13316143. 
  8. Callemeyn J, Van Haecke P, Peetermans WE, Blockmans D (2016). "Clubbing and hypertrophic osteoarthropathy: insights in diagnosis, pathophysiology, and clinical significance". Acta Clin Belg. 71 (3): 123–30. PMID 27104368. doi:10.1080/17843286.2016.1152672. 
  9. Gibb C, Smith PJ, Miller R (2013). "Clubbing". Br J Hosp Med (Lond). 74 (11): C170–2. PMID 24350360. 
  10. Morán LM, Ariza A (2013). "Hypertrophic osteoarthropathy associated to liver cirrhosis". Reumatol Clin. 9 (4): 248–9. PMID 23099284. doi:10.1016/j.reuma.2012.06.010. 
  11. Tully AS, Trayes KP, Studdiford JS (2012). "Evaluation of nail abnormalities". Am Fam Physician. 85 (8): 779–87. PMID 22534387. 
  12. Salem A, Gamil H, Hamed M, Galal S (2010). "Nail changes in patients with liver disease". J Eur Acad Dermatol Venereol. 24 (6): 649–54. PMID 19888943. doi:10.1111/j.1468-3083.2009.03476.x. 
  13. Yap FY, Skalski MR, Patel DB, Schein AJ, White EA, Tomasian A, Masih S, Matcuk GR (2017). "Hypertrophic Osteoarthropathy: Clinical and Imaging Features". Radiographics. 37 (1): 157–195. PMID 27935768. doi:10.1148/rg.2017160052. 
  14. Pitt P, Mowat A, Williams R, Hamilton E (1994). "Hepatic hypertrophic osteoarthropathy and liver transplantation". Ann. Rheum. Dis. 53 (5): 338–40. PMC 1005335Freely accessible. PMID 8017989. 
  15. Auld T, Werntz JR (2017). "Dupuytren's disease: How to recognize its early signs". J Fam Pract. 66 (3): E5–E10. PMID 28505213. 
  16. Butz M, Timmermann L, Gross J, Pollok B, Südmeyer M, Kircheis G, Häussinger D, Schnitzler A (2014). "Cortical activation associated with asterixis in manifest hepatic encephalopathy". Acta Neurol. Scand. 130 (4): 260–7. PMID 24372275. doi:10.1111/ane.12217. 
  17. Mendizabal M, Silva MO (2010). "Images in clinical medicine. Asterixis". N. Engl. J. Med. 363 (9): e14. PMID 20842766. doi:10.1056/NEJMicm0911157. 
  18. Schiano TD (2010). "Clinical management of hepatic encephalopathy". Pharmacotherapy. 30 (5 Pt 2): 10S–5S. PMID 20412035. doi:10.1592/phco.30.pt2.10S. 
  19. , <"https://commons.wikimedia.org/wiki/File%3ADupuytren%C2%B4s_Contracture_on_the_ring_finger.jpg">via Wikimedia Commons
  20. "File:Muehrcke's lines.JPG - Wikimedia Commons". 

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