Chronic Liver Disease

Please examine this patient's abdomen

start with peripheral then the abdomen

Remember to position the patient supine (1 pillow) and go to the end of the bed to inspect the patient

Nails

- Leuconychia

- Clubbing

Hands

- Palmar erythema

- Dupuytren's contracture

Check for flapping tremor

Face

- Pallor

- Jaundice

- Parotid swelling

Chest

- Spider naevi

- Loss of axillary hair

Leg

- Pedal edema

Abdomen

Ask for PR if anaemia, ask for examining the testicular atrophy

Besides the signs mentioned, try to look for the underlying cause for the liver cirrhosis - eg. tattoos (Hep B,C), parotid swelling/Dupuytren's contracture(alcohol), xanthalesma/excoriation marks esp middle aged ladies(Primary Biliary Cirrhosis), Hyperpigmentation (Haemachromatosis), KF ring/Chorea movements(Wilson's Disease), if paucity of liver cirrhosis signs(Hep C)

Diagnosis

Level 1 - Hepatomegaly or splenomegaly or hepatosplenomegaly

Level 2 - Chronic liver disease/Liver cirrhosis

Level 3 - Pulmonary hypertension (splenomegaly, ascites)

Level 4 - Hepatic encephalopathy ( flapping tremor/constructional apraxia) - Complication

Level 5 - Hep B/Hep C/alcohol....as above - Cause

Causes of enlarged liver in chronic liver disease

- Alcoholic liver disease

- Primary biliary cirrhosis

- Malignant transformation

Investigations

Blood tests(FBC, BUSE/cr, LFT, Coag)

Tests for underlying cause (Hep BsAg, Anti HCV, GGT, serum ceruloplasmin, urine copper, AMA, ANA, Anti Sm, iron studies)

U/S Abdomen or CT scan abdomen