Portal hypertension physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

Physical examination of patients with portal hypertension is usually remarkable for splenomegaly, caput medusae, and thrombocytopenia. The presence of jaundice on physical examination is highly suggestive of cirrhosis. Patients with portal hypertension usually appear ill and icteric.

Physical Examination

Spider angioma-By Herbert L. Fred, MD and Hendrik A. van Dijk, via wikimedia.org

Abdominal distention, ascites-By James Heilman, MD (Own work)

Dupuytren´s Contracture on the ring finger-By MikkTooming (Own work)

• Patients with portal hypertension are usually asymptomatic at early stages of the disease.
• Physical examination of patients with portal hypertension is usually remarkable for splenomegaly, caput medusae, and thrombocytopenia.
• The presence of jaundice on physical examination is highly suggestive of cirrhosis.

Appearance of the Patient

• Patients with portal hypertension usually appear ill and icteric.

Vital Signs

• Low-grade fever
• High-grade fever in spontaneous bacterial peritonitis (SBP)
• Tachypnea in congestive heart failure (CHF)
• Bounding pulse
• Arterial hypotension

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Skin

• Jaundice
• Spider angiomas
• Pallor in severe internal bleeding
• Telangiectasis

Neck

• Jugular venous distension in CHF

Heart

• Flow murmur over the pericardium
• Mild heave

Abdomen

• Abdominal distention in ascites
• Shifting dullness in ascites
• Abdominal tenderness in all abdominal quadrants due to SBP
• Rebound tenderness (positive Blumberg sign) in SBP
• Guarding may be present in SBP
• Splenomegaly
• Dilated veins on abdominal wall, suggestive of umbilical epigastric vein shunts
• Venous patterns on the flanks, suggestive of parieto-portal shunts
• Caput medusae, i.e. tortuous paraumbilical collateral veins
• Paraumblical hernia
• Gynecomastia
• Venous hums

Genitourinary

• Rectal hemorrhoids
• Loss of pubic hair in cirrhosis
• Testicular atrophy in cirrhosis

Neuromuscular

• Hepatic encephalopathy
• Altered mental status

Extremities

• Dupuytrens contracture
• Muscle wasting in cirrhosis
• Palmar erythema in cirrhosis
• Leukonychia in cirrhosis
• Asterixis in hepatic encephalopathy
• Cyanosis
• Pitting edema of the lower extremities