Liver Disease, Head to Foot

Introduction

The signs of liver disease are for the most part to be found OUTSIDE the abdomen. The goal of this Stanford Medicine 25 session is for you to be able to list these signs from head to foot.

Head

  • Fetor hepaticus
  • Constructional apraxia
    • Patients cannot reproduce simple designs (e.g. a star of David)
  • Drowsiness and confusion
  • Parotid gland enlargement
  • Spider angiomas
  • Icterus

 

Bilateral parotid swelling (Credit)

Chest

  • Diminished axillary hair
  • Spider angioma
  • Gynecomastia in a male

Hands

  • Asterixis
  • Palmar erythema (PALE HAND WITH ISLANDS OF REDNESS OVER THENAR AND HYPOTHENAR EMINENCE)
  • Duputryen’s contracture
  • Clubbing (only in biliary cirrhosis)
  • Terry’s “half & half” nails

Duputryen's contracture (Credit)


Terry's nails

Other

  • Petechiae and echymosis
  • Scratch marks
  • Edema
  • Testicular atrophy (and how do you know, what is normal?)
  • The development of a female escutcheon in a male (‘escutcheon’ means shield, but medically it is used to describe the pattern of distribution of coarse, adult pubic hair which is rhomboid in the male and triangular in the female with the base of the triangle up)

Abdomen Proper