Gastrointestinal varices physical examination

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

Overview

Physical examination of patients with gastrointestinal varices is usually remarkable for ascites, pallor, jaundice, tachycardia, low blood pressure in case of shock, hepatomegaly or shrunken liver (in case of cirrhosis), spleenomegaly, altered mental status, palmar erythema, cyanosis and clubbing.

Physical Examination

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

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

Skin

• Jaundice
• Pallor

HEENT

• 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