Portal hypertension physical examination: Difference between revisions
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==Physical Examination== | ==Physical Examination== | ||
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|[[image:Spider angiomata.jpg|thumb|300px|Spider angioma-By Herbert L. Fred, MD and Hendrik A. van Dijk, via wikimedia.org <ref>(http://cnx.org/content/m14900/latest/) [<"http://creativecommons.org/licenses/by/2.0">CC BY 2.0], <"https://commons.wikimedia.org/wiki/File%3ASpider_nevus.jpg">via Wikimedia Commons</ref>]] | |[[image:Spider angiomata.jpg|thumb|300px|Spider angioma-By Herbert L. Fred, MD and Hendrik A. van Dijk, via wikimedia.org<ref>(http://cnx.org/content/m14900/latest/) [<"http://creativecommons.org/licenses/by/2.0">CC BY 2.0], <"https://commons.wikimedia.org/wiki/File%3ASpider_nevus.jpg">via Wikimedia Commons</ref>]] | ||
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|[[image:Hepaticfailure.jpg|thumb|300px|Abdominal distention, ascites-By James Heilman, MD (Own work) <ref name="https://creativecommons.org/licenses/by-sa/3.0", CC BY-SA 3.0>, <"https://commons.wikimedia.org/wiki/File%3AHepaticfailure.jpg">via Wikimedia Commons</ref>]] | |[[image:Hepaticfailure.jpg|thumb|300px|Abdominal distention, ascites-By James Heilman, MD (Own work), via wikimedia.org<ref name="https://creativecommons.org/licenses/by-sa/3.0", CC BY-SA 3.0>, <"https://commons.wikimedia.org/wiki/File%3AHepaticfailure.jpg">via Wikimedia Commons</ref>]] | ||
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|[[image:Dupuytren´s Contracture on the ring finger.jpg|thumb|300px|Dupuytren´s Contracture on the ring finger-By MikkTooming (Own work) <ref name="https://creativecommons.org/licenses/by-sa/4.0", CC BY-SA 4.0>, <"https://commons.wikimedia.org/wiki/File%3ADupuytren%C2%B4s_Contracture_on_the_ring_finger.jpg">via Wikimedia Commons</ref>]] | |[[image:Dupuytren´s Contracture on the ring finger.jpg|thumb|300px|Dupuytren´s Contracture on the ring finger-By MikkTooming (Own work), via wikimedia.org<ref name="https://creativecommons.org/licenses/by-sa/4.0", CC BY-SA 4.0>, <"https://commons.wikimedia.org/wiki/File%3ADupuytren%C2%B4s_Contracture_on_the_ring_finger.jpg">via Wikimedia Commons</ref>]] | ||
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*Patients with portal hypertension are usually [[asymptomatic]] at early stages of the [[disease]]. | *Patients with portal hypertension are usually [[asymptomatic]] at early stages of the [[disease]]. | ||
Latest revision as of 18:29, 16 February 2018
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Portal Hypertension Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Portal hypertension physical examination On the Web |
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American Roentgen Ray Society Images of Portal hypertension physical examination |
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Risk calculators and risk factors for Portal hypertension physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]
Overview
Physical examination of patients with portal hypertension is usually remarkable for splenomegaly, caput medusae, and thrombocytopenia. The presence of jaundice on physical examination is highly suggestive of cirrhosis. Patients with portal hypertension usually appear ill and icteric.
Physical Examination
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- Patients with portal hypertension are usually asymptomatic at early stages of the disease.
- Physical examination of patients with portal hypertension is usually remarkable for splenomegaly, caput medusae, and thrombocytopenia.
- The presence of jaundice on physical examination is highly suggestive of cirrhosis.
Appearance of the Patient
- Patients with portal hypertension usually appear ill and icteric.
Vital Signs
- Low-grade fever
- High-grade fever in spontaneous bacterial peritonitis (SBP)
- Tachypnea in congestive heart failure (CHF)
- Bounding pulse
- Arterial hypotension
| CHUBTgrU3Oc|600}} |
| Or65nOrcz1A|600}} |
Skin
Neck
Heart
- Flow murmur over the pericardium
- Mild heave
Abdomen
- Abdominal distention in ascites[2]
- Shifting dullness in ascites[2]
- Abdominal tenderness in all abdominal quadrants due to SBP
- Rebound tenderness (positive Blumberg sign) in SBP
- Guarding may be present in SBP
- Splenomegaly
- Dilated veins on abdominal wall, suggestive of umbilical epigastric vein shunts
- Venous patterns on the flanks, suggestive of parieto-portal shunts
- Caput medusae, i.e. tortuous paraumbilical collateral veins
- Paraumblical hernia
- Gynecomastia
- Venous hums
Genitourinary
- Rectal hemorrhoids
- Loss of pubic hair in cirrhosis
- Testicular atrophy in cirrhosis[3]
Neuromuscular
Extremities
- Dupuytrens contracture
- Muscle wasting in cirrhosis
- Palmar erythema in cirrhosis
- Leukonychia in cirrhosis
- Asterixis in hepatic encephalopathy
- Cyanosis
- Pitting edema of the lower extremities[3]
References
- ↑ (http://cnx.org/content/m14900/latest/) [<"http://creativecommons.org/licenses/by/2.0">CC BY 2.0], <"https://commons.wikimedia.org/wiki/File%3ASpider_nevus.jpg">via Wikimedia Commons
- ↑ 2.0 2.1 Hou W, Sanyal AJ (2009). "Ascites: diagnosis and management". Med. Clin. North Am. 93 (4): 801–17, vii. doi:10.1016/j.mcna.2009.03.007. PMID 19577115.
- ↑ 3.0 3.1 Escorsell A, Garcia-Pagán JC, Bosch J (2001). "Assessment of portal hypertension in humans". Clin Liver Dis. 5 (3): 575–89. PMID 11565131.
