Extrahepatic Manifestations of Liver Disease (OSCE)
NEUROLOGICAL
- LOC, delirium, coma
- asterixis (arms out, dorsiflexed hands, eyes closed → hepatic encephalopathy)
BREATHING
- Cheyne-Stokes (encephalopathy)
- Kussmaul (metabolic acidosis)
- fetor hepaticus (musty liver breath)
EYES
- scleral icterus
MOUTH
- sublingual jaundice
- parotid gland enlargement, tenderness
NECK
- spider angiomata
- blanching, necklace distribution, can be in the back
- up to 2 in men and 5 in women is normal
HANDS
- nails (clubbing, leukonychia, Lindsay’s, Terry’s nails)
- palmar erythema (ulnar)
- Dupuytren’s contracture
- thenar muscle wasting
TRUNK
- jaundice
- clotting
- ecchymosis (prothrombin deficiency)
- purpura/petechiae (platelet deficiency)
- ↑ estrogen (gynecomastia, testicular atrophy, loss of axillary and pubic hair)
ABDOMEN
- caput medusa
- ascites
- bulging flanks
- shifting dullness
- fluid wave
- hepatomegaly (initially large and firm, liver later shrinks)
- splenomegaly
LOWER LEGS
- lower extremity edema
- be reluctant to diagnose ascites without seeing swollen legs
Other OSCE modules
Acute Confusion - Acute Coronary Syndrome Orders - Anemia - Arterial Blood Gasses - Asthma - Blood Pressure - Chest pain - Chest XRay - CHF - Coma - COPD - Cranial Nerves - Diabetic History - Diabetic Foot - Dysphagia - EKGs - Gallbladder and Liver - Liver Disease - Gait and Balance - Headache - Hematemesis - Hypertension - Jugular Venous Pulses - Knee Exam - Lymph Nodes - Community Acquired Pneumonia - Parkinson Disease - Peripheral Arterial Insufficiency - Pneumonia Examination - Precordial Exam - STD's - Spleen - Swollen Leg Exam - Thyroid Exam - Upper vs Lower Motor Neuron Lesions - Urinary Incontinence
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