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
Physical examination of patients with gastrointestinal varices is usually remarkable for the following findings on physical examination:
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
- Low blood pressure due to blood loss in case of bleeding varices
Skin
HEENT
- Abnormalities of the head may show 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