Hepatitis C physical examination: Difference between revisions
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{{Hepatitis C}} | {{Hepatitis C}} | ||
{{CMG}} | {{CMG}} ; '''Associate Editor(s)-In-Chief:''' {{JA}} | ||
== | ==Overview== | ||
Patients with hepatitis C typically have a normal [[physical exam]]. In patients with advanced disease, physical exam signs of liver [[cirrhosis]] may be apparent. | |||
==Physical Exam== | |||
Patients with acute and chronic hepatitis C usually have a normal physical exam. Patients with more advanced disease manifest findings observed in patients with liver [[cirrhosis]]. A complete [[physical exam]] is important to assess patients with hepatitis C to guide the optimal choice of therapy. However, [[patients]] with significant [[liver]] [[fibrosis]] have normal findings on physical examination. | |||
<center>'''Findings in patients with chronic HCV'''<ref name="pmid15053407">{{cite journal| author=Ward RP, Kugelmas M, Libsch KD| title=Management of hepatitis C: evaluating suitability for drug therapy. | journal=Am Fam Physician | year= 2004 | volume= 69 | issue= 6 | pages= 1429-36 | pmid=15053407 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15053407 }} </ref><ref name="Kaplan2020">{{cite journal|last1=Kaplan|first1=David E.|title=Hepatitis C Virus|journal=Annals of Internal Medicine|volume=173|issue=5|year=2020|pages=ITC33–ITC48|issn=0003-4819|doi=10.7326/AITC202009010}}</ref></center> | |||
{| {{table}}| | |||
| align="center" style="background:#f0f0f0;"|'''Physical Exam''' | |||
| align="center" style="background:#f0f0f0;"|'''Comments''' | |||
|- | |||
| Abdomen||Evidence of hepatic inflammation or hepatomegaly, signs of cirrhosis may be present including ascites (shifting dullness), splenomegaly, and caput medusae | |||
|- | |||
| Cardiovascular system||Underlying [[cardiovascular disease]] may affect the choice of therapy. CVD is a relative contraindication to treatment with the combination of pegylated interferon and ribavirin. | |||
|- | |||
| Extremities||Peripheral [[pitting edema]] can be a sign of [[portal hypertension]]. [[Cryoglobulinemic vasculitis]]. | |||
|- | |||
| General appearance||[[Malnutrition]] can be a sign of advanced liver disease. Temporal wasting, [[spider nevi]], [[scleral]] [[icterus]], and terry [[nail]]s. | |||
|- | |||
| HEENT||[[Thyroid]] abnormalities; treatment can cause or exacerbate [[autoimmune thyroiditis]]. | |||
|- | |||
| ||[[Icterus]] | |||
|- | |||
| Mental status||Evidence of [[psychosis]] or [[depression]], which are important contraindications to treatment. | |||
|- | |||
| Respiratory system||Perform a general examination to exclude respiratory disease. | |||
|- | |||
| Skin||Signs of [[alcohol abuse]] or liver failure, such as [[spider angioma]], dilated veins over the chest or abdomen (indicative of [[portal hypertension]]), and [[palmar erythema]]. | |||
|- | |||
| ||[[Jaundice]] and [[gynecomastia]]. | |||
|- | |||
| ||Cutaneous complications of long-term HCV infection, such as palpable purpura (associated with [[cryoglobulinemia]]) or [[blisters]] and [[vesicles]], associated with [[porphyria cutanea tarda]] | |||
|- | |||
| Weight||Weight determines the dosage of pegylated interferon and [[ribavirin]] | |||
|} | |||
<sup>Adapted from Ward RP, Kugelmas M, Libsch KD. Management of hepatitis C: evaluating suitability for drug therapy. Am Fam Physician. 2004;69(6):1429-36.</sup> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:FinalQCRequired]] | |||
[[Category:Emergency mdicine]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category:Hepatology]] | |||
Latest revision as of 23:14, 12 June 2021
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Hepatitis C |
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Diagnosis |
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Treatment |
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Hepatitis C physical examination On the Web |
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American Roentgen Ray Society Images of Hepatitis C physical examination |
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Risk calculators and risk factors for Hepatitis C physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-In-Chief: Javaria Anwer M.D.[2]
Overview
Patients with hepatitis C typically have a normal physical exam. In patients with advanced disease, physical exam signs of liver cirrhosis may be apparent.
Physical Exam
Patients with acute and chronic hepatitis C usually have a normal physical exam. Patients with more advanced disease manifest findings observed in patients with liver cirrhosis. A complete physical exam is important to assess patients with hepatitis C to guide the optimal choice of therapy. However, patients with significant liver fibrosis have normal findings on physical examination.
| Physical Exam | Comments |
| Abdomen | Evidence of hepatic inflammation or hepatomegaly, signs of cirrhosis may be present including ascites (shifting dullness), splenomegaly, and caput medusae |
| Cardiovascular system | Underlying cardiovascular disease may affect the choice of therapy. CVD is a relative contraindication to treatment with the combination of pegylated interferon and ribavirin. |
| Extremities | Peripheral pitting edema can be a sign of portal hypertension. Cryoglobulinemic vasculitis. |
| General appearance | Malnutrition can be a sign of advanced liver disease. Temporal wasting, spider nevi, scleral icterus, and terry nails. |
| HEENT | Thyroid abnormalities; treatment can cause or exacerbate autoimmune thyroiditis. |
| Icterus | |
| Mental status | Evidence of psychosis or depression, which are important contraindications to treatment. |
| Respiratory system | Perform a general examination to exclude respiratory disease. |
| Skin | Signs of alcohol abuse or liver failure, such as spider angioma, dilated veins over the chest or abdomen (indicative of portal hypertension), and palmar erythema. |
| Jaundice and gynecomastia. | |
| Cutaneous complications of long-term HCV infection, such as palpable purpura (associated with cryoglobulinemia) or blisters and vesicles, associated with porphyria cutanea tarda | |
| Weight | Weight determines the dosage of pegylated interferon and ribavirin |
Adapted from Ward RP, Kugelmas M, Libsch KD. Management of hepatitis C: evaluating suitability for drug therapy. Am Fam Physician. 2004;69(6):1429-36.
References
- ↑ Ward RP, Kugelmas M, Libsch KD (2004). "Management of hepatitis C: evaluating suitability for drug therapy". Am Fam Physician. 69 (6): 1429–36. PMID 15053407.
- ↑ Kaplan, David E. (2020). "Hepatitis C Virus". Annals of Internal Medicine. 173 (5): ITC33–ITC48. doi:10.7326/AITC202009010. ISSN 0003-4819.