Liver Disease, Head to Foot

The liver plays important roles that affect the whole body. Therefore in liver disease, it is common to see clinical findings throughout the body, from head to foot.

Introduction to the Exam for Liver Disease

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.

Findings in the Head with Liver Disease

  • 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)

Findings in the Chest with Liver Disease

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

Findings in the Hands with Liver Disease

  • 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

Findings in the Abdomen with Liver Disease

Other Findings in Liver Disease

  • 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)