Hepatitis C physical examination

Hepatitis Main Page
Hepatitis C
Home
Patient Info
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Epidemiology & Demographics
Risk Factors
Screening
Differentiating Hepatitis C from other Diseases
Natural History, Complications & Prognosis
Diagnosis
History & Symptoms
Physical Examination
Lab Tests
Electrocardiogram
Chest X Ray
CT
MRI
Ultrasound
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Future or Investigational Therapies
Hepatitis C physical examination On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Hepatitis C physical examination All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Hepatitis C physical examination
CDC on Hepatitis C physical examination
Hepatitis C physical examination in the news
Blogs on Hepatitis C physical examination
Directions to Hospitals Treating Hepatitis C
Risk calculators and risk factors for Hepatitis C physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Physical Exam

Area of examination	Comments or reason for examination
Abdomen	Evaluate for evidence of hepatic inflammation or hepatomegaly.
	Note whether ascites or splenomegaly is present.
Cardiovascular system	Known, currently symptomatic cardiovascular disease is a relative contraindication to treatment with the combination of pegylated interferon and ribavirin.
Extremities	Peripheral edema can be a sign of portal hypertension.
General nutrition	Malnutrition can be a sign of advanced liver disease.
HEENT	Check for thyroid abnormalities, because treatment can cause or exacerbate autoimmune thyroiditis.
	Note whether icterus is present.
Mental status	Check for evidence of psychosis or depression.
	The patient’s level of judgment and insight should be sufficient to understand and tolerate the treatment regimen and its possible side effects.
Respiratory system	Perform a general examination to exclude respiratory disease.
Skin	Note any signs of alcohol abuse or liver failure, such as damaged capillaries over the cheeks, dilated veins over the chest or abdomen (indicative of portal hypertension), spider nevi, and palmar erythema.
	Note the presence or absence of jaundice and gynecomastia.
	Look for cutaneous complications of long-term HCV infection, such as palpable purpura (associated with cryoglobulinemia) or blisters and vesicles (porphyria cutanea tarda).
Weight	Weight determines the dosage of pegylated interferon and ribavirin

• Acute

  • Mild or absent symptoms (7-8 weeks after exposure)

• Chronic

  • Fatigue

• Late Complications

  • Cirrhosis
  • Hepatocellular carcinoma (HCC) in cirrhotics (1-4%/year)

• Extrahepatic Symptoms

  • Cryoglobulinemia (~50%)

    • Only 10-15% of patients with +cryos have symptoms
    • Symptoms

      • Arthralgias
      • Weakness
      • Purpura
      • Membranoproliferative glomerulonephritis (MPGN)

  • Pruritus, psoriasis, Raynaud’s phenomenon (6-20%)
  • Sicca syndrome (10-12%)
  • Neuropathy (5-9%)
  • Porphyria cutanea tarda (PCT), lichen planus (1%)

References