Cirrhosis physical examination: Difference between revisions
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A few signs and symptoms may occur in the presence of cirrhosis or as a result of the complications of cirrhosis. Many are nonspecific and may occur in other diseases and do not necessarily point to cirrhosis. Likewise, the absence of any does not rule out the possibility of cirrhosis. | A few signs and symptoms may occur in the presence of cirrhosis or as a result of the complications of cirrhosis. Many are nonspecific and may occur in other diseases and do not necessarily point to cirrhosis. Likewise, the absence of any does not rule out the possibility of cirrhosis. | ||
==Physical | ==Physical Examination== | ||
===Skin=== | ===Skin=== | ||
* ''[[Spider angioma]]ta'' or ''spider nevi''. Vascular lesions consisting of central arteriole surrounded by many smaller vessels due to an increase in [[estradiol]]. These occur in about 33% of cases.<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> | * ''[[Spider angioma]]ta'' or ''spider nevi''. Vascular lesions consisting of central arteriole surrounded by many smaller vessels due to an increase in [[estradiol]]. These occur in about 33% of cases.<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> | ||
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* ''[[Fetor hepaticus]]''. Sweet pungent smell in breath due to increased [[dimethyl sulfide]] due to severe portal-systemic shunting. | * ''[[Fetor hepaticus]]''. Sweet pungent smell in breath due to increased [[dimethyl sulfide]] due to severe portal-systemic shunting. | ||
==References== | ==References== | ||
Revision as of 14:36, 9 August 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]
Overview
A few signs and symptoms may occur in the presence of cirrhosis or as a result of the complications of cirrhosis. Many are nonspecific and may occur in other diseases and do not necessarily point to cirrhosis. Likewise, the absence of any does not rule out the possibility of cirrhosis.
Physical Examination
Skin
- Spider angiomata or spider nevi. Vascular lesions consisting of central arteriole surrounded by many smaller vessels due to an increase in estradiol. These occur in about 33% of cases.[1]
- Palmar erythema. Exaggerations of normal speckled mottling of the palm, due to altered sex hormone metabolism.
- Nail changes.
- Muehrcke's nails - paired horizontal bands separated by normal color due to hypoalbuminemia (low production of albumin).
- Terry's nails - proximal two thirds of the nail plate appears white with distal one-third red, also due to hypoalbuminemia
- Clubbing --- Angle between the nail plate and proximal nail fold > 180 degrees
- Dupuytren's contracture. Thickening and shortening of palmar fascia that leads to flexion deformities of the fingers. Thought to be due to fibroblastic proliferation and disorderly collagen deposition. It is relatively common (33% of patients).
Eyes
- Jaundice. Yellow discoloring of the skin, eye, and mucus membranes due to increased bilirubin (at least 2-3 mg/dL or 30 mmol/L). Urine may also appear dark.
Abdomen
- Liver size. Can be enlarged, normal, or shrunken.
- Splenomegaly. Due to congestion of the red pulp as a result of portal hypertension.
- Ascites. Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs about 1500 mL to detect flank dullness).
- Caput medusa. In portal hypertension, the umbilical vein may open. Blood from the portal venous system may be shunted through the periumbilical veins into the umbilical vein and ultimately to the abdominal wall veins, manifesting as caput medusa.
- Cruveilhier-Baumgarten murmur. Venous hum heard in epigastric region due to collateral connections between portal system and the remnant of the umbilical vein in portal hypertension.
Extremities
- Hypertrophic osteoarthropathy. Chronic proliferative periostitis of the long bones that can cause considerable pain.
Neurologic
- Asterixis. Bilateral asynchronous flapping of outstretched, dorsiflexed hands seen in patients with hepaticencephalopathy.
Other
- Gynecomastia. Benign proliferation of glandular tissue of male breasts presenting with a rubbery or firm mass extending concentrically from the nipples. This is due to increased estradiol and can occur up to 66% of patients.
- Fetor hepaticus. Sweet pungent smell in breath due to increased dimethyl sulfide due to severe portal-systemic shunting.
References