Acute liver failure physical examination

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

Overview

Patients with acute liver failure may appear lethargic, anorexic and fatigue. In the initial stages of acute liver failure, the patient may have mild mental status changes such as altered sleep pattern but may become confused or develop coma in the later stages as the disease progresses. Physical examination of acute liver failure is remarkable for hepatomegaly, right upper quadrant abdominal tenderness, ascites and encephalopathy.

Physical Examination

Appearance of the Patient

  • Patient with acute liver failure may be appearing ill and lethargic.[1][2]
  • The patients with acute liver failure with mild mental status changes such as altered sleep pattern at initial stages may become confused or develop a comatose condition in the later stage.

Vital Signs

Skin

HEENT

Neck

Not significant

Lungs

Not significant

Heart

Not significant

Abdomen

Back

Not significant

Genitourinary

Not significant

Extremities

The extremities may have signs of easy bleeding due to coagulopathy.

Neuromuscular

Grades of Hepatic Encephalopathy

Based on their clinical manifestation, different grades of hepatic encephalopathy are defined as:[3]

  • Grade I
Grade I encephalopathy manifests with changes in behavior and minimal changes in the level of consciousness.
  • Grade II
Grade II encephalopathy manifests with inappropriate behavior, gross disorientation, drowsiness, and possibly asterixis.
  • Grade III
Grade III encephalopathy manifests with marked confusion, incoherent speech, and mostly sleeping but arousable to vocal stimuli.
  • Grade IV
Grade III encephalopathy manifests with comatose, unresponsive to pain, and decorticate or decerebrate posturing.

References

  1. Mochida S, Nakayama N, Matsui A, Nagoshi S, Fujiwara K (2008). "Re-evaluation of the Guideline published by the Acute Liver Failure Study Group of Japan in 1996 to determine the indications of liver transplantation in patients with fulminant hepatitis". Hepatol Res. 38 (10): 970–9. doi:10.1111/j.1872-034X.2008.00368.x. PMID 18462374.
  2. Hoofnagle JH, Nelson KE, Purcell RH (2012). "Hepatitis E." N Engl J Med. 367 (13): 1237–44. doi:10.1056/NEJMra1204512. PMID 23013075.
  3. Conn, HO.; Leevy, CM.; Vlahcevic, ZR.; Rodgers, JB.; Maddrey, WC.; Seeff, L.; Levy, LL. (1977). "Comparison of lactulose and neomycin in the treatment of chronic portal-systemic encephalopathy. A double blind controlled trial". Gastroenterology. 72 (4 Pt 1): 573–83. PMID 14049.



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