Hepatic encephalopathy physical examination

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

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Overview

In addition to changed level of consciousness, the hallmark of hepatic encephalopathy on the physical examination is the presence of asterixis. This is detected by having the patient hold out his outstretched arms and hands and cock his wrists back. In the presence of asterixis, there is a non-synchronized, intermittent flapping motion at the wrists. Asterixis is not specific to hepatic encephalopathy. It may also be seen in states such as renal failure and carbon dioxide retention.

Physical Examination

Skin

• Signs of liver disease, such as yellow skin and eyes.

Nose

• Signs of liver disease, such as musty odor to the breath.

Abdomen

• Signs of liver disease, such fluid collection in the abdomen (ascites), and occasionally a musty odor urine.

Neurologic

Nervous system signs may change. Signs include:

• Coarse, "flapping" shaking of the hands when attempting to hold the arms out in front of the body and lift the hands.
• Abnormal mental status, particularly cognitive (thinking) tasks such as connecting numbers with lines.