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{{Autoimmune hepatitis}}
{{Autoimmune hepatitis}}
{{CMG}}; {{AE}}:{{MKK}}
{{CMG}}; {{AE}}:{{MKK}}
==Overview==
==Overview==
Patients with autoimmune hepatitis usually appear normal. Physical examination of patients with autoimmune hepatitis are [[jaundice]], [[hepatomegaly]], [[splenomegaly]], [[hepatic encephalopathy]] and [[Spider angiomata|spider angiomata.]]


==Physical Examination==
==Physical Examination==
*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
Physical examination of Autoimmune hepatitis patient  who progresses to cirrhosis:<ref name="pmid16394302">{{cite journal |vauthors=Krawitt EL |title=Autoimmune hepatitis |journal=N. Engl. J. Med. |volume=354 |issue=1 |pages=54–66 |year=2006 |pmid=16394302 |doi=10.1056/NEJMra050408 |url=}}</ref>
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*[[Jaundice]]
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
*[[Hepatomegaly]]  
 
*[[Spider angiomata]]
===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with autoimmune hepatitis usually appear normal initially. If it progresses then patient appear weak due to constitutional symptoms such as [[weight loss]], [[anorexia]], and [[muscle atrophy]].
 
*Yellowish discoloration of the skin.
===Vital Signs===
*[[Abdominal distension]] may also be present due to [[ascites|ascites.]]
 
*Normal/low blood pressure with normal pulse pressure.
*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]
 
===Skin===
===Skin===
*[[Jaundice]]
*[[Jaundice]]
 
*[[Spider angioma|Spider angiomata]]<ref name="pmid10423070">{{cite journal |author=Li CP, Lee FY, Hwang SJ, ''et al'' |title=Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function|journal=Scand. J. Gastroenterol. |volume=34 |issue=5 |pages=520-3 |year=1999 |pmid=10423070 |doi=}}</ref> 
 
<gallery widths="250px">
<gallery widths=150px>
<gallery widths="250px">
 
File:Spider nevus.jpg|[[spider angiomata]] |Spider angiomata<ref>https://commons.wikimedia.org/wiki/File:Spider_nevus.jpg#/media/</ref>
UploadedImage-01.jpg | Description {{dermref}}
File:Cholangitis Jaundice.jpg|thumb|250px|Sclerotic jaundice in a female <ref>By Bobjgalindo - Own work, GFDL, https://commons.wikimedia.org/w/index.php?curid=10762793</ref>
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>
</gallery>
===HEENT===
===HEENT===
* Abnormalities of the head/hair may include ___
*[[Hirsutism]]
* Evidence of trauma
*[[Icteric sclera]]  
* Icteric sclera
*[[Acne]]
* [[Nystagmus]]  
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accomodation / non-reactive to neither light nor accomodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae / tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
 
===Neck===
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]
 
===Lungs===
* Asymmetric chest expansion / Decreased chest expansion
*Lungs are hypo/hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds / Distant breath sounds
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
 
===Heart===
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope
 
===Abdomen===
===Abdomen===
*[[Abdominal distention]]  
*[[Abdominal distention]](Ascites)
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Hepatomegaly]]  
*[[Rebound tenderness]] (positive Blumberg sign)
*[[splenomegaly]]
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*[[Caput medusae]]
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
 
===Back===
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
 
===Neuromuscular===
===Neuromuscular===
*Patient is usually oriented to persons, place, and time
*[[Hepatic encephalopathy]] patient presents with:
* Altered mental status
**Altered mental status
* Glasgow coma scale is ___ / 15
**[[Confusion]]
* Clonus may be present
**[[Coma]]
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)
 
===Extremities===
*[[Clubbing]]  
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Latest revision as of 17:26, 9 January 2018

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

Overview

Patients with autoimmune hepatitis usually appear normal. Physical examination of patients with autoimmune hepatitis are jaundice, hepatomegaly, splenomegaly, hepatic encephalopathy and spider angiomata.

Physical Examination

Physical examination of Autoimmune hepatitis patient who progresses to cirrhosis:[1]

Appearance of the Patient

  • Patients with autoimmune hepatitis usually appear normal initially. If it progresses then patient appear weak due to constitutional symptoms such as weight loss, anorexia, and muscle atrophy.
  • Yellowish discoloration of the skin.
  • Abdominal distension may also be present due to ascites.
  • Normal/low blood pressure with normal pulse pressure.

Skin

  • Spider angiomata[3]

    Spider angiomata[3]

  • Sclerotic jaundice in a female [4]

    Sclerotic jaundice in a female [4]

HEENT

Abdomen

Neuromuscular

References

  1. ↑ Krawitt EL (2006). "Autoimmune hepatitis". N. Engl. J. Med. 354 (1): 54–66. doi:10.1056/NEJMra050408. PMID 16394302.
  2. ↑ Li CP, Lee FY, Hwang SJ; et al. (1999). "Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function". Scand. J. Gastroenterol. 34 (5): 520–3. PMID 10423070.
  3. ↑ https://commons.wikimedia.org/wiki/File:Spider_nevus.jpg#/media/
  4. ↑ By Bobjgalindo - Own work, GFDL, https://commons.wikimedia.org/w/index.php?curid=10762793

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