Alcoholic liver disease physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Alcoholic liver disease}} | {{Alcoholic liver disease}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{MKA}} {{CP}} | ||
==Overview== | ==Overview== | ||
There are certain stigmata associated with alcoholic liver disease that one should look for on physical examination. These include; [[jaundice]], [[gynecomastia]], [[spider angiomata]], [[bruising]], [[hepatosplenomegaly]], [[ascites]], [[testicular atrophy]], [[asterixis]], and [[palmar erythema]]. A thorough [[neurologic]] and [[mental status exam]] should also be done to assess for signs of [[hepatic encephalopathy]], or other [[neurologic]] deficits that may be caused by chronic [[alcohol]] use. | |||
==Physical Examination== | ==Physical Examination== | ||
Physical examination of alcoholic liver disease includes:<ref name="pmid1198096">{{cite journal |vauthors=Baraona E, Leo MA, Borowsky SA, Lieber CS |title=Alcoholic hepatomegaly: accumulation of protein in the liver |journal=Science |volume=190 |issue=4216 |pages=794–5 |year=1975 |pmid=1198096 |doi= |url=}}</ref><ref name="pmid11113085">{{cite journal |vauthors=Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O |title=Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial |journal=Gastroenterology |volume=119 |issue=6 |pages=1637–48 |year=2000 |pmid=11113085 |doi= |url=}}</ref><ref name="pmid6421159">{{cite journal |vauthors=Mendenhall CL, Anderson S, Weesner RE, Goldberg SJ, Crolic KA |title=Protein-calorie malnutrition associated with alcoholic hepatitis. Veterans Administration Cooperative Study Group on Alcoholic Hepatitis |journal=Am. J. Med. |volume=76 |issue=2 |pages=211–22 |year=1984 |pmid=6421159 |doi= |url=}}</ref><ref name="pmid3131572">{{cite journal |vauthors=Pirovino M, Linder R, Boss C, Köchli HP, Mahler F |title=Cutaneous spider nevi in liver cirrhosis: capillary microscopical and hormonal investigations |journal=Klin. Wochenschr. |volume=66 |issue=7 |pages=298–302 |year=1988 |pmid=3131572 |doi= |url=}}</ref><ref name="pmid2910764">{{cite journal |vauthors=Dutta SK, Dukehart M, Narang A, Latham PS |title=Functional and structural changes in parotid glands of alcoholic cirrhotic patients |journal=Gastroenterology |volume=96 |issue=2 Pt 1 |pages=510–8 |year=1989 |pmid=2910764 |doi= |url=}}</ref><ref name="pmid3983651">{{cite journal |vauthors=Van Thiel DH, Gavaler JS, Schade RR |title=Liver disease and the hypothalamic pituitary gonadal axis |journal=Semin. Liver Dis. |volume=5 |issue=1 |pages=35–45 |year=1985 |pmid=3983651 |doi=10.1055/s-2008-1041756 |url=}}</ref><ref name="pmid7227854">{{cite journal |vauthors=Epstein O, Dick R, Sherlock S |title=Prospective study of periostitis and finger clubbing in primary biliary cirrhosis and other forms of chronic liver disease |journal=Gut |volume=22 |issue=3 |pages=203–6 |year=1981 |pmid=7227854 |pmc=1419499 |doi= |url=}}</ref><ref name="pmid3592873">{{cite journal |vauthors=Attali P, Ink O, Pelletier G, Vernier C, Jean F, Moulton L, Etienne JP |title=Dupuytren's contracture, alcohol consumption, and chronic liver disease |journal=Arch. Intern. Med. |volume=147 |issue=6 |pages=1065–7 |year=1987 |pmid=3592873 |doi= |url=}}</ref><ref>Erlinger S, Benhamou J. Cirrhosis: clinical aspects. In: Mcintyre N, Benhamou J, Rizzetto M, editors. Oxford textbook of clinical hepatology. Oxford: University Press; 1991. p. 380.</ref><ref>Groszman R, Franchis R. Portal hypertension. In: Schiff E, Sorrell M, Maddrey W, editors. Diseases of the liver. Philadelphia: Lippincot Williams & Wilkens; 1999. p. 415.</ref> | |||
===Vitals=== | ===Vitals=== | ||
* Fever may be present | * [[Fever]] may be present | ||
===Head and Neck=== | ===Head and Neck=== | ||
* [[Fetor hepaticus]] (breath smelling like a freshly opened corpse) | * [[Fetor hepaticus]] (breath smelling like a freshly opened corpse) | ||
* Parotid hypertrophy | * [[Parotid]] [[hypertrophy]] | ||
* Poor dentition | * Poor dentition | ||
* [[ | * Scleral [[icterus]] | ||
===Skin=== | ===Skin=== | ||
* [[Jaundice]] | * [[Jaundice]] | ||
* Abnormal dark or light patches of skin | * Abnormal dark or light patches of [[skin]] | ||
* [[Spider angiomata]] | * [[Spider angiomata]] | ||
* [[Gynecomastia]] | * [[Gynecomastia]] | ||
* Bruising or other indications of | * [[Bruising]] or other indications of [[thrombocytopenia]] | ||
* [[Striae]] | |||
===Abdomen=== | ===Abdomen=== | ||
* [[Hepatosplenomegaly]] | * [[Hepatosplenomegaly]] | ||
* [[Abdominal distention]] | * [[Abdominal distention]] | ||
* Palpable liver edge | * Palpable [[liver]] edge | ||
* Abdominal tenderness | * [[Abdominal tenderness]] | ||
* [[Ascites]] | * [[Ascites]] | ||
* Fluid wave (due to ascites) | * Fluid wave (due to [[ascites]]) | ||
* Right upper quadrant tenderness | * [[RUQ|Right upper quadrant]] [[tenderness]] | ||
===Genitourinary=== | ===Genitourinary=== | ||
* [[Testicular atrophy]] | * [[Testicular atrophy]] | ||
=== | ===Extremities=== | ||
*[[Muscle atrophy]] | *[[Muscle atrophy]] | ||
* [[Asterixis]] | * [[Asterixis]] | ||
| Line 39: | Line 45: | ||
===Neurologic=== | ===Neurologic=== | ||
* Confusion, coma ([[encephalopathy]]) may be present | * [[Confusion]], [[coma]] ([[encephalopathy]]) may be present | ||
* Evidence of Wernicke's or Korsakoff syndrome | * Evidence of [[Wernicke's]] or [[Korsakoff's]] syndrome | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WS}} | |||
{{WH}} | |||
[[Category:Surgery]] | |||
[[Category: | |||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category: | [[Category:Up-To-Date]] | ||
[[Category:Hepatology]] | [[Category:Hepatology]] | ||
[[Category:Medicine]] | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2] Charmaine Patel, M.D. [3]
Overview
There are certain stigmata associated with alcoholic liver disease that one should look for on physical examination. These include; jaundice, gynecomastia, spider angiomata, bruising, hepatosplenomegaly, ascites, testicular atrophy, asterixis, and palmar erythema. A thorough neurologic and mental status exam should also be done to assess for signs of hepatic encephalopathy, or other neurologic deficits that may be caused by chronic alcohol use.
Physical Examination
Physical examination of alcoholic liver disease includes:[1][2][3][4][5][6][7][8][9][10]
Vitals
- Fever may be present
Head and Neck
- Fetor hepaticus (breath smelling like a freshly opened corpse)
- Parotid hypertrophy
- Poor dentition
- Scleral icterus
Skin
- Jaundice
- Abnormal dark or light patches of skin
- Spider angiomata
- Gynecomastia
- Bruising or other indications of thrombocytopenia
- Striae
Abdomen
- Hepatosplenomegaly
- Abdominal distention
- Palpable liver edge
- Abdominal tenderness
- Ascites
- Fluid wave (due to ascites)
- Right upper quadrant tenderness
Genitourinary
Extremities
Neurologic
- Confusion, coma (encephalopathy) may be present
- Evidence of Wernicke's or Korsakoff's syndrome
References
- ↑ Baraona E, Leo MA, Borowsky SA, Lieber CS (1975). "Alcoholic hepatomegaly: accumulation of protein in the liver". Science. 190 (4216): 794–5. PMID 1198096.
- ↑ Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O (2000). "Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial". Gastroenterology. 119 (6): 1637–48. PMID 11113085.
- ↑ Mendenhall CL, Anderson S, Weesner RE, Goldberg SJ, Crolic KA (1984). "Protein-calorie malnutrition associated with alcoholic hepatitis. Veterans Administration Cooperative Study Group on Alcoholic Hepatitis". Am. J. Med. 76 (2): 211–22. PMID 6421159.
- ↑ Pirovino M, Linder R, Boss C, Köchli HP, Mahler F (1988). "Cutaneous spider nevi in liver cirrhosis: capillary microscopical and hormonal investigations". Klin. Wochenschr. 66 (7): 298–302. PMID 3131572.
- ↑ Dutta SK, Dukehart M, Narang A, Latham PS (1989). "Functional and structural changes in parotid glands of alcoholic cirrhotic patients". Gastroenterology. 96 (2 Pt 1): 510–8. PMID 2910764.
- ↑ Van Thiel DH, Gavaler JS, Schade RR (1985). "Liver disease and the hypothalamic pituitary gonadal axis". Semin. Liver Dis. 5 (1): 35–45. doi:10.1055/s-2008-1041756. PMID 3983651.
- ↑ Epstein O, Dick R, Sherlock S (1981). "Prospective study of periostitis and finger clubbing in primary biliary cirrhosis and other forms of chronic liver disease". Gut. 22 (3): 203–6. PMC 1419499. PMID 7227854.
- ↑ Attali P, Ink O, Pelletier G, Vernier C, Jean F, Moulton L, Etienne JP (1987). "Dupuytren's contracture, alcohol consumption, and chronic liver disease". Arch. Intern. Med. 147 (6): 1065–7. PMID 3592873.
- ↑ Erlinger S, Benhamou J. Cirrhosis: clinical aspects. In: Mcintyre N, Benhamou J, Rizzetto M, editors. Oxford textbook of clinical hepatology. Oxford: University Press; 1991. p. 380.
- ↑ Groszman R, Franchis R. Portal hypertension. In: Schiff E, Sorrell M, Maddrey W, editors. Diseases of the liver. Philadelphia: Lippincot Williams & Wilkens; 1999. p. 415.