Medicine Notes- Clinical Examination - Chronic Liver Disease
Chronic liver disease
The common causes of chronic liver disease are excessive alcohol intake, non alcoholic steatohepatitis, autoimmune hepatitis, infective hepatitis, primary biliary cirrhosis, paracetamol, Wilson’s disease, hemochromatosis and alpha 1 antitrypsin deficiency.
Patient may appear cachetic with distention of the abdomen. Hands examination may reveal hepatic flap, clubbing, palmar erythema and Dupuytren’s contracture as well as leukonychia. Patient may appear hypotensive. There will be yellow discoloration of the sclera ( jaundice) and the present of Kayser- Fleischer ring on the eye. Patient with chronic liver disease may also present with gynecomastia and spider nevi. There will also be caput medusa which is a distention of the veins. Palpation may reveal enlargement of the spleen /splenomegaly and in few cases enlargement of the liver /hepatomegaly. However, hepatomegaly is a rare condition in cirrhotic liver. Abdominal percussion may reveal dullness over the spleen and the liver. There will also be shifting dullness. Patient may present with edema due to portal hypertension or hypoalbuminemia.
The common complications of chronic liver disease are clotting abnormalities, hepatorenal failure , encephalopathy and ascites. Liver screen test may include hepatitis serology, paracetamol level measurements, iron studies, liver enzyme analysis, abdominal ultrasound, liver biopsy and ascitic tap.
The common causes of chronic liver disease are excessive alcohol intake, non alcoholic steatohepatitis, autoimmune hepatitis, infective hepatitis, primary biliary cirrhosis, paracetamol, Wilson’s disease, hemochromatosis and alpha 1 antitrypsin deficiency.
Patient may appear cachetic with distention of the abdomen. Hands examination may reveal hepatic flap, clubbing, palmar erythema and Dupuytren’s contracture as well as leukonychia. Patient may appear hypotensive. There will be yellow discoloration of the sclera ( jaundice) and the present of Kayser- Fleischer ring on the eye. Patient with chronic liver disease may also present with gynecomastia and spider nevi. There will also be caput medusa which is a distention of the veins. Palpation may reveal enlargement of the spleen /splenomegaly and in few cases enlargement of the liver /hepatomegaly. However, hepatomegaly is a rare condition in cirrhotic liver. Abdominal percussion may reveal dullness over the spleen and the liver. There will also be shifting dullness. Patient may present with edema due to portal hypertension or hypoalbuminemia.
The common complications of chronic liver disease are clotting abnormalities, hepatorenal failure , encephalopathy and ascites. Liver screen test may include hepatitis serology, paracetamol level measurements, iron studies, liver enzyme analysis, abdominal ultrasound, liver biopsy and ascitic tap.
