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.
Related Topics
Privacy Policy, Terms and Conditions, DMCA Policy and Compliant
Copyright © 2018-2024 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.