Hepatocellular carcinoma physical examination: Difference between revisions
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===Genitourinary=== | |||
*[[Testicular atrophy]] | |||
*Inversion of the normal male [[pubic hair]] pattern | |||
===Neuromuscular=== | |||
* [[Hepatic encephalopathy]] may have signs of: | |||
** Alteration of [[Mental status examination|mental status]] | |||
** [[Confusion]] | |||
** [[Coma]] | |||
* [[Asterixis]] (bilateral but asynchronous flapping motions of outstretched, dorsiflexed hands) is seen in patients with [[hepatic encephalopathy]]. | |||
{{#ev:youtube|Or65nOrcz1A}} | |||
==References== | ==References== | ||
Revision as of 16:04, 5 January 2018
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Differentiating Hepatocellular carcinoma from other Diseases |
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Hepatocellular carcinoma physical examination On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]
Overview
Patients with hepatocellular carcinoma usually appear cachectic. Physical examination of patients with hepatocellular carcinoma is usually remarkable for jaundice, pruritus, ascites, splenomegaly, esophageal varices, and cachexia.
Physical Examination
Common physical examination findings of hepatocellular carcinoma are:
Appearance of the Patient
- The general appearance of the patient depends on the severity of the disease:
- The patient is often cachexic
- May appear anxious.
- Dyspnea if ascites is present
Vitals
Temperature
- Fever is usually present in advanced cases
Skin
- Jaundice : yellow discoloration of the skin, eyes, and mucus membranes due to increased bilirubin (at least 2-3 mg/dL or 30 mmol/L). Urine may also appear dark.
- Pallor
- Bruises
- Peripheral Edema
- Palmar erythema on the thenar and hypothenar eminences, due to altered sex hormone metabolism.
- Spider angiomata: Increased estradiol levels lead to the formation of vascular lesions consisting of central arterioles surrounded by smaller vessels [1]
HEENT
- Abnormalities of the head/hair may include thinning of hair on the scalp due to hyperestrogenism
- Kayser-Fleischer rings: dark rings that appear to encircle the iris of the eye in patients with Wilson's disease[2]
- Icteric sclera
- Parotid gland enlargement
- Fetor hepaticus: severe portal-systemic shunting leads to increased levels of dimethyl sulfide leads to a sweet pungent smell in the breath
-
Telingectasias
Source: Wikimedia commons -
![Palmar erythema Source: Wikimedia commons[3]](/images/8/86/Palmar_erythema_1.jpg)
Palmar erythema
Source: Wikimedia commons[3]
![Palmar erythema Source: Wikimedia commons[3]](/index.php/File:Palmar_erythema_1.jpg)
{{#ev:youtube|RT-8OzD9j00}}
Lungs
- The signs of pleural effusion are noted in advanced disease
Abdomen
Significant abdominal findings are seen in advanced stages
- Inspection:
- Palpation:
- Fluid wave
- Hepatomegaly may be present in initial stages. The liver may also be normal or shrunken.
- Spleenomegaly may be present in patients with cirrhosis from nonalcoholic etiologies, due to portal hypertension
- Percussion:
- Flank dullness may be present due to ascites (needs approximately 1500ml for detection)
- Auscultation:
- Cruveilhier-Baumgarten murmur: venous hum that may be present in patients with portal hypertension.
- Mechanism: due to collateral connections between remnant of the umbilical vein and the portal system
- Location: Epigastrium
- Exacerbating factors: Valsalva maneuver
- Diminished by: application of pressure on the skin above the umbilicus
- Cruveilhier-Baumgarten murmur: venous hum that may be present in patients with portal hypertension.
-
Abdominal distention, ascites-By James Heilman, MD (Own work) Invalid parameter in<ref>tag
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Genitourinary
- Testicular atrophy
- Inversion of the normal male pubic hair pattern
Neuromuscular
- Hepatic encephalopathy may have signs of:
- Alteration of mental status
- Confusion
- Coma
- Asterixis (bilateral but asynchronous flapping motions of outstretched, dorsiflexed hands) is seen in patients with hepatic encephalopathy.
{{#ev:youtube|Or65nOrcz1A}}
References
- ↑ 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.
- ↑ Sridhar MS, Rangaraju A, Anbarasu K, Reddy SP, Daga S, Jayalakshmi S, Shaik B (2017). "Evaluation of Kayser-Fleischer ring in Wilson disease by anterior segment optical coherence tomography". Indian J Ophthalmol. 65 (5): 354–357. doi:10.4103/ijo.IJO_400_16. PMC 5565897. PMID 28573989.
- ↑ "File:Kawasaki symptoms D.jpg - Wikimedia Commons".
- ↑ Kim, SH; Keum, B; Kim, ES; Jeen, YT; Chun, HJ (2014). "Hepatobiliary and Pancreatic: Caput medusae". Journal of Gastroenterology and Hepatology. 29 (12): 1952–1952. doi:10.1111/jgh.12802. ISSN 0815-9319.
- ↑ Chandail VS, Jamwal V (2013). "Caput medusae". J Assoc Physicians India. 61 (8): 564. PMID 24818343.
