Extrahepatic Manifestations of Liver Disease (OSCE)

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Contents 1 NEUROLOGICAL 2 BREATHING 3 EYES 4 MOUTH 5 NECK 6 HANDS 7 TRUNK 8 ABDOMEN 9 LOWER LEGS 10 Other OSCE modules

[edit] NEUROLOGICAL

• LOC, delirium, coma
• asterixis (arms out, dorsiflexed hands, eyes closed → hepatic encephalopathy)

[edit] BREATHING

• Cheyne-Stokes (encephalopathy)
• Kussmaul (metabolic acidosis)
• fetor hepaticus (musty liver breath)

[edit] EYES

• scleral icterus

[edit] MOUTH

• sublingual jaundice
• parotid gland enlargement, tenderness

[edit] NECK

• spider angiomata
  • blanching, necklace distribution, can be in the back
  • up to 2 in men and 5 in women is normal

[edit] HANDS

• nails (clubbing, leukonychia, Lindsay’s, Terry’s nails)
• palmar erythema (ulnar)
• Dupytren’s contracture
• thenar muscle wasting

[edit] TRUNK

• jaundice
• clotting
  • ecchymosis (prothrombin deficiency)
  • purpura/petechiae (platelet deficiency)
• ↑ estrogen (gynecomastia, testicular atrophy, loss of axillary and pubic hair)

[edit] ABDOMEN

• caput medusa
• ascities
  • bulging flanks
  • shifting dullness
  • fluid wave
• hepatomegaly (initially large and firm, liver later shrinks)
• splenomegaly

[edit] LOWER LEGS

• lower extremity edema
  • be reluctant to diagnose ascites without seeing swollen legs

[edit] Other OSCE modules