Extrahepatic Manifestations of Liver Disease (OSCE)

NEUROLOGICALEdit

  • LOC, delirium, coma
  • asterixis (arms out, dorsiflexed hands, eyes closed → hepatic encephalopathy)

BREATHINGEdit

  • Cheyne-Stokes (encephalopathy)
  • Kussmaul (metabolic acidosis)
  • fetor hepaticus (musty liver breath)

EYESEdit

  • scleral icterus

MOUTHEdit

  • sublingual jaundice
  • parotid gland enlargement, tenderness

NECKEdit

  • spider angiomata
    • blanching, necklace distribution, can be in the back
    • up to 2 in men and 5 in women is normal

HANDSEdit

  • nails (clubbing, leukonychia, Lindsay’s, Terry’s nails)
  • palmar erythema (ulnar)
  • Dupuytren’s contracture
  • thenar muscle wasting

TRUNKEdit

  • jaundice
  • clotting
    • ecchymosis (prothrombin deficiency)
    • purpura/petechiae (platelet deficiency)
  • ↑ estrogen (gynecomastia, testicular atrophy, loss of axillary and pubic hair)

ABDOMENEdit

  • caput medusa
  • ascites
    • bulging flanks
    • shifting dullness
    • fluid wave
  • hepatomegaly (initially large and firm, liver later shrinks)
  • splenomegaly

LOWER LEGSEdit

  • lower extremity edema
    • be reluctant to diagnose ascites without seeing swollen legs

Other OSCE modulesEdit