1. Clinical Assessment of the Adult Patient with Possible Liver Disease: History and Physical Examination
- E. Jenny Heathcote MB, BS, MD, FRCP, FRCP(C)2,3,4,5
Published Online: 4 SEP 2012
Copyright © 2012 John Wiley & Sons, Ltd
Hepatology: Diagnosis and Clinical Management
How to Cite
Renner, E. L. (2012) Clinical Assessment of the Adult Patient with Possible Liver Disease: History and Physical Examination, in Hepatology: Diagnosis and Clinical Management (ed E. J. Heathcote), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118314968.ch1
Francis Family Chair in Hepatology Research, Toronto, Ontario, Canada
University of Toronto, Toronto, Ontario, Canada
Patient Based Clinical Research Division, Toronto Western Research Institute, Toronto, Ontario, Canada
University Health Network/Toronto Western Hospital, Toronto, Ontario, Canada
- Published Online: 4 SEP 2012
- Published Print: 12 OCT 2012
Print ISBN: 9780470656174
Online ISBN: 9781118314968
- risk factor;
- physical examination;
• Current illness; are the symptoms suggestive of or compatible with liver disease?
• Past medical history: anything associated with liver disease?
• Review of systems: are there symptoms/signs suggestive of or compatible with liver disease?
• Family: is there any known liver disease in the family?
• Medications: list all prescription/non-prescription/alternative medicines.
• Risk factors: high-risk sexual behavior, alcohol and illicit drug use, transfusions, piercing, tattoos, travel or history of living in the “developing world”.
• Social: occupation, social support?
• General condition/vital signs: jaundice, malnutrition, muscle wasting, low blood pressure/elevated heart rate
• Neurocognitive status: hepatic encephalopathy(hepatic fetor, “liver” flap)
• Abdomen: liver (size, consistency, tenderness), spleen size, ascites, prominent abdominal wall veins/ caput medusae, hernias
• Skin/nails: spider nevi, palmar erythema, Dupuytren's contractures, clubbing
• Heart and lungs: hepatic hydrothorax, elevated jugular venous pressure
• Miscellaneous:gynecomastia, parotid hypertrophy, peripheral edema, peripheral polyneuropathy