1. Clinical Assessment of the Adult Patient with Possible Liver Disease: History and Physical Examination

  1. E. Jenny Heathcote MB, BS, MD, FRCP, FRCP(C)2,3,4,5
  1. Eberhard L. Renner MD, FRCP(C)1,3

Published Online: 4 SEP 2012

DOI: 10.1002/9781118314968.ch1

Hepatology: Diagnosis and Clinical Management

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

Editor Information

  1. 2

    Francis Family Chair in Hepatology Research, Toronto, Ontario, Canada

  2. 3

    University of Toronto, Toronto, Ontario, Canada

  3. 4

    Patient Based Clinical Research Division, Toronto Western Research Institute, Toronto, Ontario, Canada

  4. 5

    University Health Network/Toronto Western Hospital, Toronto, Ontario, Canada

Author Information

  1. 1

    GI Transplantation, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada

  2. 3

    University of Toronto, Toronto, Ontario, Canada

Publication History

  1. Published Online: 4 SEP 2012
  2. Published Print: 12 OCT 2012

ISBN Information

Print ISBN: 9780470656174

Online ISBN: 9781118314968

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Keywords:

  • history;
  • risk factor;
  • physical examination;
  • management

Summary

History

• 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?

Physical examination

• 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