Visual Examination for Liver Disease

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Do not palpate the abdomen of the patient immediately.  Make sure to obtain important clues to the disease. 

General Condition

In patients with suspected liver disease, it is important to obtain visually obtained clues to liver disease.  It is necessary to determine whether patients have jaundice, muscle wasting, cutaneous stigmata of liver disease, abdominal distention, and peripheral edema.

 

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The vital signs of patients may indicate hyperdynamic circulation with a resting tachycardia , which is characteristic of cirrhosis, wide pulse pressure, which is the difference between systolic pressure and diastolic pressure, and low blood pressure due to peripheral vasodilation.  A cirrhotic patient may exhale fetor hepaticus having a musty smell.  Exhale fetor must be distinguished from halitosis due to poor oral hygiene.

Mucocutaneous Findings

Jaundice can be detected in the sclera or under the tongue, where elastin tissue retains bilirubin, of the patient.  Temporal muscle wasting and paper money skin are signs of advanced liver disease.  Patients with cholestatic liver disease may have xanthelasma due to lipid deposits on the eyelids and skin around the orbital cavity.  Spider nevi on the face and thorax especially in women are not characteristic of liver disease, but they are suggestive if it is present at more than a few locations.  Palmar erythema in women may be normal but suggests liver disease in men.  Dupuytren’s contracture is a disease that retracts the palmar fascia with subsequent contracture of the palms and fingers.  This disease can be a sign of alcoholic liver disease.  Petechiae and ecchymoses represent production impairment of clotting factors and hypersplenism in advanced liver disease.  Patients with advanced liver disease may present with white color patches on the nails.  Patients with cholestatic liver disease may present with scratch marks of pruritus on their trunk and extremities.