Hepatitis C physical examination

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

Overview

Physical Exam

Patients with acute and chronic hepatitis C usually have a benign physical exam. Patients with more advanced disease manifest findings seen in patients with liver cirrhosis. A complete physical exam is important to assess patients with hepatitis C to guide the choice of therapy.

Findings in patients with chronic HCV

Physical Exam	Comments
Abdomen	Evidence of hepatic inflammation or hepatomegaly, signs of cirrhosis may be present including ascites (shifting dullness), splenomegaly, caput medusae, etc.
Cardiovascular system	Assess for underlying cardiovascular disease (CVD) since it may affect the choice of therapy since CVD 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 appearance	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, which are important contraindications to treatment.
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 angiomata, 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

^{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