Physical Examination

General Appearance: Poor nutritional status, slurred speech, disorientation, diaphoresis.

Vital Signs: BP (hypertension), pulse (tachycardia), respiratory rate, temperature (hyperthermia).

HEENT: Signs of head trauma, ecchymoses. Conjunctival injection, icterus, nystagmus, extraocular movements, pupil reactivity.

Chest: Rhonchi, crackles (aspiration), gynecomastia (cirrhosis).

Heart: Irregular rhythm, murmurs.

Abdomen: Liver tenderness, hepatomegaly or liver atrophy, liver span, splenomegaly, ascites.

Genitourinary: Testicular atrophy, hernias.

Rectal: Occult blood.

Skin: Jaundice, spider angiomas (stellate arterioles with branching capillaries), palmar erythema, muscle atrophy (stigmata of liver disease); needle tracks.

Extremities: Dupuytren's contracture (fibrotic palmar ridge to ring finger).

Neuro: Mood, affect, speech patterns, depressed mood. Cranial nerves 2-12, reflexes, ataxia. Asterixis, decreased vibratory sense (peripheral neuropathy).

Wernicke's Encephalopathy: Ophthalmoplegia, ataxia, confusion (thiamine deficiency).

Korsakoff's Syndrome: Retrograde or antegrade amnesia, confabulation.

Labs: Electrolytes, magnesium, glucose, liver function tests, CBC, mean corpuscular volume, gamma-glutamyltransferase, aspartate aminotransferase (AST), alanine aminotransferase (ALT), carbohydrate-deficient transferrin (CDT). UA; chest X-ray; ECG.

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