Chapter: Medicine and surgery: Hepatic, biliary and pancreatic systems

Signs of chronic liver disease

There are many signs of chronic liver disease, but in some cases examination can be entirely normal, despite advanced disease.

Signs of chronic liver disease

 

There are many signs of chronic liver disease, but in some cases examination can be entirely normal, despite advanced disease (see Fig. 5.2).


 

The hands:

 

Clubbing of the fingers.


Leuconychia – the nail appears white and opaque, but the distal end is often spared, it is thought to be due to hypoalbuminaemia.

 

Palmar erythema although commonly seen in liver disease, it is also associated with pregnancy, thyrotox-icosis, other diseases and may occur in healthy people. It has been attributed to increased levels of circulating oestrogens, due to altered metabolism.

 

Dupuytren’s contracture is a thickening of the palmar fascia which may be palpable as thickening or cords and as it progresses flexes the fingers (most commonly the ring and little fingers). It has many causes, including an inherited tendency, but is associated with alcoholic cirrhosis.

The eyes and face:

 

Jaundice should be looked for.

 

Xanthelasma (cholesterol deposits on the eyelids) are seen in primary biliary cirrhosis.

 

Parotid enlargement occurs in alcoholism.

 

Hepatic fetor is a sweet smell of the breath, which

 

occurs in advanced liver failure. The chest and upper arms:

 

Spider naevi are telangiectases that consist of a central arteriole with radiating small vessels. They blanch if pressure is applied to the centre, then refill outwards. Up to five spider naevi are said to be normal.

 

Scratch marks due to pruritus, particularly in primary biliary cirrhosis.

Gynaecomastia, which may be due to increased oestrogen levels or drugs such as spironalactone. Loss of axillary hair is another sign.

 

Tattoos may indicate a possible source of previous hepatitis infection.

 

Slategrey pigmentation of the skin occurs in haemochromatosis.

 

There may be a hepatic flap, which is a flapping tremor of the outstretched hands.

 

The abdomen and lower limbs:

 

Hepatomegaly and/or splenomegaly. Ascites.

 

Caput medusa (see below). Testicular atrophy in males.

 

Ankle oedema (due to right heart failure or hypoalbuminaemia).

 

In early cirrhosis liver function is adequate, so that patients are asymptomatic and do not have complications. In more severe disease portal hypertension, low serum albumin and other complications occur. This is called decompensated cirrhosis. Patients may fluctuate back and forth, depending on intercurrent events such as infections.

 

Signs of decompensated cirrhosis:

 

·        Deep jaundice.

 

·        Ascites, with or without peripheral oedema.

 

·        Hepatic encephalopathy, i.e. any drowsiness, confusion, hepatic flap and hepatic fetor.

 

·        Development of dilated collateral veins, i.e. veins around the umbilicus (caput medusa, which are very rare) or oesophageal varices, which can lead to upper gastrointestinal haemorrhage.

 

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Medicine and surgery: Hepatic, biliary and pancreatic systems : Signs of chronic liver disease |

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Medicine and surgery: Hepatic, biliary and pancreatic systems


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