Hepatopulmonary syndrome physical examination: Difference between revisions
Jump to navigation
Jump to search
| Line 21: | Line 21: | ||
*[[Cyanosis]] | *[[Cyanosis]] | ||
*[[Jaundice]] | |||
*[[Palmar erythema]] | |||
*[[Spider angioma|Spider angiomata]] | |||
<br /> | <br /> | ||
| Line 41: | Line 44: | ||
===Lungs=== | ===Lungs=== | ||
* Pulmonary examination of patients with hepatopulmonary syndrome might be normal. | * Pulmonary examination of patients with hepatopulmonary syndrome might be normal. | ||
* Sometimes , in patients with sever [[ascites]]. | |||
* | *Distant and decreased breath sounds in pulmonary bases. | ||
* | |||
===Heart=== | ===Heart=== | ||
* Cardiovascular examination of patients with hepatopulmonary syndrome | * Cardiovascular examination of patients with hepatopulmonary syndrome might be normal. | ||
* | *Because Cirrhosis complicated with HPS is a high cardiac output condition the following might be present: | ||
*[[Heave]] / [[thrill]] | *[[Heave]] / [[thrill]] | ||
*[[Heart sounds#Third heart sound S3|S3]] | *[[Heart sounds#Third heart sound S3|S3]] | ||
*[[Heart sounds#Fourth heart sound S4|S4]] | *[[Heart sounds#Fourth heart sound S4|S4]] | ||
*[[Heart sounds#Summation Gallop|Gallops]] | *[[Heart sounds#Summation Gallop|Gallops]] | ||
* | *[[Friction rub]] (due to cirrhosis complications) | ||
===Abdomen=== | ===Abdomen=== | ||
* Abdominal examination of patients with hepatopulmonary syndrome | * Abdominal examination of patients with hepatopulmonary syndrome could be normal. | ||
*[[Abdominal distension]] | *With respect to the cirrhosis severity and other complications rather than HPS, the followings might be present: | ||
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant | *[[Abdominal distension]] | ||
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant in [[SBP|'''spontaneous bacterial peritonitis (SBP)''']] | |||
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant | *A palpable abdominal mass in the right/left upper/lower abdominal quadrant in [[Hepatocellular carcinoma|'''hepatocellular carcinoma''']] | ||
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]] | *[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]] | ||
===Back=== | ===Back=== | ||
* Back examination of patients with hepatopulmonary syndrome is usually normal. | * Back examination of patients with hepatopulmonary syndrome is usually normal. | ||
===Genitourinary=== | ===Genitourinary=== | ||
* Genitourinary examination of patients with hepatopulmonary syndrome is usually normal. | * Genitourinary examination of patients with hepatopulmonary syndrome is usually normal. | ||
*[[Gynecomastia|Gynaecomastia]] | |||
* | |||
===Neuromuscular=== | ===Neuromuscular=== | ||
* Neuromuscular examination of patients with hepatopulmonary syndrome is usually normal. | * Neuromuscular examination of patients with hepatopulmonary syndrome is usually normal. | ||
*in the presence of sever complicated cirrhosis with or without HPS, astrexis, cognitive disturbance, loss of consciousness, coma and death is possible. | |||
* | |||
* Altered mental status | *Altered mental status | ||
* | * Bilateral tremor () | ||
===Extremities=== | ===Extremities=== | ||
Revision as of 16:12, 31 July 2019
|
Hepatopulmonary syndrome Microchapters |
|
Differentiating Hepatopulmonary syndrome from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Hepatopulmonary syndrome physical examination On the Web |
|
American Roentgen Ray Society Images of Hepatopulmonary syndrome physical examination |
|
Risk calculators and risk factors for Hepatopulmonary syndrome physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]
Overview
Physical examination of patients with hepatopulmonary syndrome is usually remarkable for liver disease findings such as jaundice, palmar erythema, spider angiomata, gynaecomastia ,abdominal distension, caput medusae, splenomegaly either with or without sign and symptoms of hypoxemia such as cyanosis and clubbing.The presence of platypnea on physical examination is highly suggestive of hepatopulmonary syndrome.
Physical Examination
Physical examination of patients with hepatopulmonary syndrome is usually remarkable for liver disease findings such as jaundice, palmar erythema, spider angiomata, gynaecomastia ,abdominal distension, caput medusae, splenomegaly either with or without sign and symptoms of hypoxemia such as cyanosis and clubbing.The presence of platypnea on physical examination is highly suggestive of hepatopulmonary syndrome.
Appearance of the Patient
- Patients with hepatopulmonary syndrome may appear either normal, cyanotic, jaundiced, or ill, depend on the severity of their liver disease and HPS stage.
Vital Signs
- Platypnea (symptom)
- Orthodeoxia (sign), a drop of 4mmHg in PaO2 or, 5% in saturation when moving from the supine to the standing position.
{{#ev:youtube|1wEWw2cdXn0}}
Skin
- Skin examination of patients with hepatopulmonary syndrome moight reveal, spider angiomata . (likelihood of HPS 21%).
{{#ev:youtube|RT-8OzD9j00}}
HEENT
- HEENT examination of patients with hepatopulmonary syndrome might be either normal, show sign and symptoms of hypoxemia such as cyanotic mucosal membranes, or findings of liver disease such as:
- Thinning of hair on the scalp due to hyperestrogenism
- Kayser-Fleischer rings in patients with Wilson's disease[1]
- Fetor hepaticus
Neck
- Neck examination of patients with hepatopulmonary syndrome is usually normal.
- Parotid gland enlargement might e present as a cirrhosis related finding.
- The following might be present in the differential diagnosis of HPS but neither role out nor role in HPS diagnosis.
Lungs
- Pulmonary examination of patients with hepatopulmonary syndrome might be normal.
- Sometimes , in patients with sever ascites.
- Distant and decreased breath sounds in pulmonary bases.
Heart
- Cardiovascular examination of patients with hepatopulmonary syndrome might be normal.
- Because Cirrhosis complicated with HPS is a high cardiac output condition the following might be present:
- Heave / thrill
- S3
- S4
- Gallops
- Friction rub (due to cirrhosis complications)
Abdomen
- Abdominal examination of patients with hepatopulmonary syndrome could be normal.
- With respect to the cirrhosis severity and other complications rather than HPS, the followings might be present:
- Abdominal distension
- Abdominal tenderness in the right/left upper/lower abdominal quadrant in spontaneous bacterial peritonitis (SBP)
- A palpable abdominal mass in the right/left upper/lower abdominal quadrant in hepatocellular carcinoma
- Hepatomegaly / splenomegaly / hepatosplenomegaly
Back
- Back examination of patients with hepatopulmonary syndrome is usually normal.
Genitourinary
- Genitourinary examination of patients with hepatopulmonary syndrome is usually normal.
- Gynaecomastia
Neuromuscular
- Neuromuscular examination of patients with hepatopulmonary syndrome is usually normal.
- in the presence of sever complicated cirrhosis with or without HPS, astrexis, cognitive disturbance, loss of consciousness, coma and death is possible.
- Altered mental status
- Bilateral tremor ()
Extremities
- Clubbing
- Cyanosis
- Palmar erythema (cirrhosis sign)
- Edema (due to decreased albumin production in a malfunctioning liver)
References
- ↑ 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.