Gastrointestinal varices physical examination

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

Physical Examination

Physical examination of patients with gastrointestinal varices is usually remarkable for the following findings on physical examination:

Appearance of the Patient

• Patients with gastrointestinal varices due to chronic liver disease usually appear weak and disoriented. Patient may have pallor if there is active bleeding from varices

Vital Signs

• Tachycardia
• Low blood pressure in case of shock due to severe bleeding from ruptured varices

• Tachycardia with bounding pulses
• Tachypnea in case of hepatopulmonary syndrome
• Low blood pressure due to blood loss in case of bleeding varices

Skin

• Jaundice
• Pallor

HEENT

• Abnormalities of the head may show pallor in conjunctiva and cyanosis of the tongue, lips, and peripheries, due to low oxygen saturation
• Telangiectasis of the lips

Neck

• Lymphadenopathy incase of lymphoma

Heart

• S1 + S2 + 0
• Chest examination may reveal gynecomastia in males from failure of liver to metabolize estrogen (normally occurs in the liver)

Abdomen

• Abdominal distention due to ascites
• Dilated veins in the anterior abdominal wall
• Caput medusae (tortuous paraumbilical collateral veins)
• Hepatomegaly / splenomegaly
• Paraumbilical hernia
• Liver may be shrunken in case of cirrhosis

Genitourinary

• Testicular atrophy in males
• Rectal hemorrhoids
• Tarry stools filling the rectal vault on rectal exam

Neuromuscular

• Patient is will not be oriented to time, person or place in case of hepatic decompensation
• Altered mental status
• Asterixis

Extremities

• Clubbing
• Cyanosis
• Dupuytren contracture
• Muscle wasting
• Palmar erythema and leukonychia