Hepatitis C physical examination: Difference between revisions
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{{Hepatitis C}} | {{Hepatitis C}} | ||
{{CMG}} | {{CMG}} | ||
== | ==Overview== | ||
==Physical Exam== | |||
{| {{table}} | |||
| align="center" style="background:#f0f0f0;"|'''Area of examination''' | |||
| align="center" style="background:#f0f0f0;"|'''Comments or reason for examination''' | |||
|- | |||
| Abdomen||Evaluate for evidence of hepatic inflammation or hepatomegaly. | |||
|- | |||
| ||Note whether ascites or splenomegaly is present. | |||
|- | |||
| Cardiovascular system||Known, currently symptomatic cardiovascular disease is a relative contraindication to treatment with the combination of pegylated interferon and ribavirin. | |||
|- | |||
| Extremities||Peripheral edema can be a sign of portal hypertension. | |||
|- | |||
| General nutrition||Malnutrition can be a sign of advanced liver disease. | |||
|- | |||
| HEENT||Check for thyroid abnormalities, because treatment can cause or exacerbate autoimmune thyroiditis. | |||
|- | |||
| ||Note whether icterus is present. | |||
|- | |||
| Mental status||Check for evidence of psychosis or depression. | |||
|- | |||
| ||The patient’s level of judgment and insight should be sufficient to understand and tolerate the treatment regimen and its possible side effects. | |||
|- | |||
| Respiratory system||Perform a general examination to exclude respiratory disease. | |||
|- | |||
| Skin||Note any signs of alcohol abuse or liver failure, such as damaged capillaries over the cheeks, dilated veins over the chest or abdomen (indicative of portal hypertension), spider nevi, and palmar erythema. | |||
|- | |||
| ||Note the presence or absence of jaundice and gynecomastia. | |||
|- | |||
| ||Look for cutaneous complications of long-term HCV infection, such as palpable purpura (associated with cryoglobulinemia) or blisters and vesicles (porphyria cutanea tarda). | |||
|- | |||
| Weight||Weight determines the dosage of pegylated interferon and ribavirin | |||
|- | |||
| | |||
|} | |||
* '''Acute''' | * '''Acute''' | ||
*:* Mild or absent symptoms (7-8 weeks after exposure) | *:* Mild or absent symptoms (7-8 weeks after exposure) | ||
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*:* [[Neuropathy]] (5-9%) | *:* [[Neuropathy]] (5-9%) | ||
*:* [[Porphyria cutanea tarda]] (PCT), [[lichen planus]] (1%) | *:* [[Porphyria cutanea tarda]] (PCT), [[lichen planus]] (1%) | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} |
Revision as of 06:32, 28 July 2014
Hepatitis C |
Diagnosis |
Treatment |
Hepatitis C physical examination On the Web |
American Roentgen Ray Society Images of Hepatitis C physical examination |
Risk calculators and risk factors for Hepatitis C physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Physical Exam
Area of examination | Comments or reason for examination |
Abdomen | Evaluate for evidence of hepatic inflammation or hepatomegaly. |
Note whether ascites or splenomegaly is present. | |
Cardiovascular system | Known, currently symptomatic cardiovascular disease is a relative contraindication to treatment with the combination of pegylated interferon and ribavirin. |
Extremities | Peripheral edema can be a sign of portal hypertension. |
General nutrition | Malnutrition can be a sign of advanced liver disease. |
HEENT | Check for thyroid abnormalities, because treatment can cause or exacerbate autoimmune thyroiditis. |
Note whether icterus is present. | |
Mental status | Check for evidence of psychosis or depression. |
The patient’s level of judgment and insight should be sufficient to understand and tolerate the treatment regimen and its possible side effects. | |
Respiratory system | Perform a general examination to exclude respiratory disease. |
Skin | Note any signs of alcohol abuse or liver failure, such as damaged capillaries over the cheeks, dilated veins over the chest or abdomen (indicative of portal hypertension), spider nevi, and palmar erythema. |
Note the presence or absence of jaundice and gynecomastia. | |
Look for cutaneous complications of long-term HCV infection, such as palpable purpura (associated with cryoglobulinemia) or blisters and vesicles (porphyria cutanea tarda). | |
Weight | Weight determines the dosage of pegylated interferon and ribavirin |
- Acute
- Mild or absent symptoms (7-8 weeks after exposure)
- Chronic
- Late Complications
- Cirrhosis
- Hepatocellular carcinoma (HCC) in cirrhotics (1-4%/year)
- Extrahepatic Symptoms
- Cryoglobulinemia (~50%)
- Only 10-15% of patients with +cryos have symptoms
- Symptoms
- Pruritus, psoriasis, Raynaud’s phenomenon (6-20%)
- Sicca syndrome (10-12%)
- Neuropathy (5-9%)
- Porphyria cutanea tarda (PCT), lichen planus (1%)
- Cryoglobulinemia (~50%)