Alcoholic liver disease physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2] Charmaine Patel, M.D. [3]
Overview
There are certain stigmata associated with alcoholic liver disease that one should look for on physical examination. These include; jaundice, gynecomastia, spider angiomata, bruising, hepatosplenomegaly, ascites, testicular atrophy, asterixis, and palmar erythema. A thorough neurologic and mental status exam should also be done to assess for signs of hepatic encephalopathy, or other neurologic deficits that may be caused by chronic alcohol use.
Physical Examination
Physical examination of alcoholic liver disease includes:[1][2][3][4][5][6][7][8][9][10]
Vitals
- Fever may be present
Head and Neck
- Fetor hepaticus (breath smelling like a freshly opened corpse)
- Parotid hypertrophy
- Poor dentition
- Scleral icterus
Skin
- Jaundice
- Abnormal dark or light patches of skin
- Spider angiomata
- Gynecomastia
- Bruising or other indications of thrombocytopenia
- Striae
Abdomen
- Hepatosplenomegaly
- Abdominal distention
- Palpable liver edge
- Abdominal tenderness
- Ascites
- Fluid wave (due to ascites)
- Right upper quadrant tenderness
Genitourinary
Extremities
Neurologic
- Confusion, coma (encephalopathy) may be present
- Evidence of Wernicke's or Korsakoff's syndrome
References
- ↑ Baraona E, Leo MA, Borowsky SA, Lieber CS (1975). "Alcoholic hepatomegaly: accumulation of protein in the liver". Science. 190 (4216): 794–5. PMID 1198096.
- ↑ Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O (2000). "Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial". Gastroenterology. 119 (6): 1637–48. PMID 11113085.
- ↑ Mendenhall CL, Anderson S, Weesner RE, Goldberg SJ, Crolic KA (1984). "Protein-calorie malnutrition associated with alcoholic hepatitis. Veterans Administration Cooperative Study Group on Alcoholic Hepatitis". Am. J. Med. 76 (2): 211–22. PMID 6421159.
- ↑ Pirovino M, Linder R, Boss C, Köchli HP, Mahler F (1988). "Cutaneous spider nevi in liver cirrhosis: capillary microscopical and hormonal investigations". Klin. Wochenschr. 66 (7): 298–302. PMID 3131572.
- ↑ Dutta SK, Dukehart M, Narang A, Latham PS (1989). "Functional and structural changes in parotid glands of alcoholic cirrhotic patients". Gastroenterology. 96 (2 Pt 1): 510–8. PMID 2910764.
- ↑ Van Thiel DH, Gavaler JS, Schade RR (1985). "Liver disease and the hypothalamic pituitary gonadal axis". Semin. Liver Dis. 5 (1): 35–45. doi:10.1055/s-2008-1041756. PMID 3983651.
- ↑ Epstein O, Dick R, Sherlock S (1981). "Prospective study of periostitis and finger clubbing in primary biliary cirrhosis and other forms of chronic liver disease". Gut. 22 (3): 203–6. PMC 1419499. PMID 7227854.
- ↑ Attali P, Ink O, Pelletier G, Vernier C, Jean F, Moulton L, Etienne JP (1987). "Dupuytren's contracture, alcohol consumption, and chronic liver disease". Arch. Intern. Med. 147 (6): 1065–7. PMID 3592873.
- ↑ Erlinger S, Benhamou J. Cirrhosis: clinical aspects. In: Mcintyre N, Benhamou J, Rizzetto M, editors. Oxford textbook of clinical hepatology. Oxford: University Press; 1991. p. 380.
- ↑ Groszman R, Franchis R. Portal hypertension. In: Schiff E, Sorrell M, Maddrey W, editors. Diseases of the liver. Philadelphia: Lippincot Williams & Wilkens; 1999. p. 415.