Physical Examination

Rosacea Free Forever

Rosacea Free Forever Cure

Get Instant Access

General Appearance: Muscle wasting, fetor hepaticas (malodorous breath). Note whether the patient appears ill, well, or malnourished.

Vital Signs: Pulse, BP, temperature (fever), respiratory rate.

Skin: Jaundice, spider angiomas (stellate, erythematous arterioles), palmar erythema; bronze skin discoloration (hemochromatosis), purpura, loss of body hair.

HEENT: Kayser-Fleischer rings (bronze corneal pigmentation, Wilson's disease), jugulovenous distention (fluid overload). Parotid enlargement, scleral icterus, gingival hemorrhage (thrombocytopenia).

Chest: Bibasilar crackles, gynecomastia.

Abdomen: Bulging flanks, tenderness, rebound (peritonitis); fluid wave, shifting dullness, "puddle sign" (flick over lower abdomen while auscultating for dullness). Courvoisier's sign (palpable nontender gallbladder with jaundice; pancreatic malignancy); atrophic liver; liver texture (blunt, irregular, firm), splenomegaly. Umbilical or groin hernias (ascites).

Genitourinary: Scrotal edema, testicular atrophy.

Extremities: Lower extremity edema.

Neuro: Confusion, asterixis (jerking movement of hand with wrist hyperextension; hepatic encephalopathy).

Rectal: Occult blood, hemorrhoids.

Stigmata of Liver Disease: Spider angiomas (stellate, red arterioles), jaundice, bronze discoloration (hemochromatosis), dilated periumbilical collateral veins (Caput medusae), ecchymoses, umbilical eversion, venous hum and thrill at umbilicus (Cruveilhier-Baumgarten syndrome); palmar erythema, Dupuytren's contracture (fibrotic palmar ridge to ring finger). Lacrimal and parotid gland enlargement, testicular atrophy, gynecomastia, ascites, encephalopathy, edema.

Labs: CBC, electrolytes, LFTs, albumin, INR/PTT, liver function tests, bilirubin, UA. Hepatitis serologies, antimitochondrial, antibody (primary biliary cirrhosis), ANA, anti-Smith antibody, ceruloplasmin, urine copper (Wilson's disease), alpha-1-antitrypsin, serum iron, TIBC, ferritin (hemochromatosis).

Abdominal X-ray: Hepatic angle sign (loss of lower margin of right lateral liver angle), separation or centralization of bowel loops, generalized abdominal haziness (ascites). Ultrasound, paracentesis.

Differential Diagnosis of Cirrhosis: Alcoholic liver disease, viral hepatitis (B, C, D), hemochromatosis, primary biliary cirrhosis, autoimmune hepatitis, inborn error of metabolism (Crigler Najjar syndrome; Wilson's disease, alpha-1-antitrypsin deficiency), heart failure, venous outflow obstruction (Budd-Chiari, portal vein thrombus).

Evaluation of Ascites Fluid

Etiology

Appe

Pro-

Serum/flui

RBC

WBC

Other

Cirrho-

Straw

<3 g/dL

>1 1

low

<250 cells/

Bacterial

Perito-

Cloud y

<3

>1 1

>250

Bacteria on gram stain and culture

Secondary Bacte-

Perito-

lent

>3

<1.1

>1000 0

Bacteria on gram stain and culture

Neo-

Straw /bloo dy

>3

>1000 lymph

Malignant cells glycer-

n

Clear

>3

<1 1

-

>1000 lymph

Acid fast bacilli

Heart

Straw

>3

>1 1

low

<1000

Pan-

Turbid

>3

<1 1

varies

varies

Elevated amylase,

Was this article helpful?

0 0
Using Exercise To Get Rid Of Man Boobs

Using Exercise To Get Rid Of Man Boobs

In this guide, youll learn just what kinds of exercises you can use to get rid of man boobs forever. It includes two different types of exercises those designed to burn body fat, helping you lose excess weight all over your body and targeted chest exercises which will shrink your man boobs until you have a masculine, sexy chest.

Get My Free Ebook


Post a comment