Extrahepatic Manifestations of Liver Disease (OSCE)
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NEUROLOGICAL
[edit | edit source]- LOC, delirium, coma
- asterixis (arms out, dorsiflexed hands, eyes closed → hepatic encephalopathy)
BREATHING
[edit | edit source]- Cheyne-Stokes (encephalopathy)
- Kussmaul (metabolic acidosis)
- fetor hepaticus (musty liver breath)
EYES
[edit | edit source]- scleral icterus
MOUTH
[edit | edit source]- sublingual jaundice
- parotid gland enlargement, tenderness
NECK
[edit | edit source]- spider angiomata
- blanching, necklace distribution, can be in the back
- up to 2 in men and 5 in women is normal
HANDS
[edit | edit source]- nails (clubbing, leukonychia, Lindsay’s, Terry’s nails)
- palmar erythema (ulnar)
- Dupuytren’s contracture
- thenar muscle wasting
TRUNK
[edit | edit source]- jaundice
- clotting
- ecchymosis (prothrombin deficiency)
- purpura/petechiae (platelet deficiency)
- ↑ estrogen (gynecomastia, testicular atrophy, loss of axillary and pubic hair)
ABDOMEN
[edit | edit source]- caput medusa
- ascites
- bulging flanks
- shifting dullness
- fluid wave
- hepatomegaly (initially large and firm, liver later shrinks)
- splenomegaly
LOWER LEGS
[edit | edit source]- lower extremity edema
- be reluctant to diagnose ascites without seeing swollen legs