Hepatitis C physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-In-Chief: Javaria Anwer M.D.[2]

Overview

Patients with hepatitis C typically have a normal physical exam. In patients with advanced disease, physical exam signs of liver cirrhosis may be apparent.

Physical Exam

Patients with acute and chronic hepatitis C usually have a normal physical exam. Patients with more advanced disease manifest findings observed in patients with liver cirrhosis. A complete physical exam is important to assess patients with hepatitis C to guide the optimal choice of therapy. However, patients with significant liver fibrosis have normal findings on physical examination.

Findings in patients with chronic HCV

Physical Exam	Comments
Abdomen	Evidence of hepatic inflammation or hepatomegaly, signs of cirrhosis may be present including ascites (shifting dullness), splenomegaly, and caput medusae
Cardiovascular system	Underlying cardiovascular disease may affect the choice of therapy. CVD is a relative contraindication to treatment with the combination of pegylated interferon and ribavirin.
Extremities	Peripheral pitting edema can be a sign of portal hypertension. Cryoglobulinemic vasculitis.
General appearance	Malnutrition can be a sign of advanced liver disease. Temporal wasting, spider nevi, scleral icterus, and terry nails.
HEENT	Thyroid abnormalities; treatment can cause or exacerbate autoimmune thyroiditis.
	Icterus
Mental status	Evidence of psychosis or depression, which are important contraindications to treatment.
Respiratory system	Perform a general examination to exclude respiratory disease.
Skin	Signs of alcohol abuse or liver failure, such as spider angioma, dilated veins over the chest or abdomen (indicative of portal hypertension), and palmar erythema.
	Jaundice and gynecomastia.
	Cutaneous complications of long-term HCV infection, such as palpable purpura (associated with cryoglobulinemia) or blisters and vesicles, associated with porphyria cutanea tarda
Weight	Weight determines the dosage of pegylated interferon and ribavirin

^{Adapted from Ward RP, Kugelmas M, Libsch KD. Management of hepatitis C: evaluating suitability for drug therapy. Am Fam Physician. 2004;69(6):1429-36.}

References