Portal hypertension physical examination: Difference between revisions
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{{Portal hypertension}} | {{Portal hypertension}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}}{{EG}} | ||
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==Overview== | ==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 [[Jaundice|icteric]]. | |||
==Physical Examination== | ==Physical Examination== | ||
*Primarily 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=== | ||
* [[Splenomegaly]] | *Patients with portal hypertension usually appear ill and [[Jaundice|icteric]]. | ||
* [[ | ===Vital Signs=== | ||
*[[Low-grade fever]] | |||
*High-grade [[fever]] in [[Spontaneous bacterial peritonitis|spontaneous bacterial peritonitis (SBP)]] | |||
*[[Tachypnea]] in [[Congestive heart failure|congestive heart failure (CHF)]] | |||
*Bounding pulse | |||
*[[Arterial]] [[hypotension]] | |||
===Skin=== | |||
*[[Jaundice]] | |||
* [[Spider angioma|Spider angiomas]] | |||
* [[Pallor]] in severe [[internal bleeding]] | |||
* [[Telangiectasis]] | |||
===Neck=== | |||
*[[Jugular venous distension]] in [[CHF]] | |||
===Heart=== | |||
* Flow [[Heart murmur|murmur]] over the [[pericardium]] | |||
* Mild [[heave]] | |||
===Abdomen=== | |||
*[[Abdominal distention]] in [[ascites]]<ref name="pmid19577115">{{cite journal |vauthors=Hou W, Sanyal AJ |title=Ascites: diagnosis and management |journal=Med. Clin. North Am. |volume=93 |issue=4 |pages=801–17, vii |year=2009 |pmid=19577115 |doi=10.1016/j.mcna.2009.03.007 |url=}}</ref> | |||
*[[Shifting dullness]] in [[ascites]]<ref name="pmid19577115" /> | |||
*[[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 veins|paraumbilical collateral veins]] | |||
*[[Abdominal hernia|Paraumblical hernia]] | |||
*[[Gynecomastia]] | |||
*[[Venous]] hums | |||
===Genitourinary=== | |||
*[[Hemorrhoids|Rectal hemorrhoids]] | |||
*Loss of [[pubic hair]] in [[cirrhosis]] | |||
*[[Testicular atrophy]] in [[cirrhosis]]<ref name="pmid11565131">{{cite journal |vauthors=Escorsell A, Garcia-Pagán JC, Bosch J |title=Assessment of portal hypertension in humans |journal=Clin Liver Dis |volume=5 |issue=3 |pages=575–89 |year=2001 |pmid=11565131 |doi= |url=}}</ref> | |||
=== | === Neuromuscular === | ||
* [[Hepatic encephalopathy]] | * [[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|Pitting edema]] of the [[lower extremities]]<ref name="pmid11565131" /> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 15:24, 2 November 2017
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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
- Primarily 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
Skin
Neck
Heart
- Flow murmur over the pericardium
- Mild heave
Abdomen
- Abdominal distention in ascites[1]
- Shifting dullness in ascites[1]
- 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[2]
Neuromuscular
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[2]
References
- ↑ 1.0 1.1 Hou W, Sanyal AJ (2009). "Ascites: diagnosis and management". Med. Clin. North Am. 93 (4): 801–17, vii. doi:10.1016/j.mcna.2009.03.007. PMID 19577115.
- ↑ 2.0 2.1 Escorsell A, Garcia-Pagán JC, Bosch J (2001). "Assessment of portal hypertension in humans". Clin Liver Dis. 5 (3): 575–89. PMID 11565131.