The Stanford 25

An Initiative to Revive the Culture of Bedside Medicine

Liver Disease, Head to Foot

Introduction: The signs of liver disease are for the most part to be found OUTSIDE the abdomen. The goal of this Stanford 25 session is for you to be able to list these signs from head to foot including the following:

  • HEAD

    Bilateral parotid swelling. Click for image credit via acpinternist.org.

    • Fetor hepaticus.
    • Constructional apraxia.
      • Patients cannot reproduce simple designs (eg, a star of David).
    • Drowsiness and confusion.
    • Parotid gland enlargement.
    • Spider angiomas.
    • Icterus.
  • CHEST
    • Diminished axillary hair.
    • Spider angioma.
    • Gynecomastia in a male.

      Dupuytren’s contracture. Click for image credit via en.academic.ru

  • HANDS
    • 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.
  • OTHER

    Terry's Half & half nails. Image credit sixwise.com

    • 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.
  • ABDOMEN PROPER
    • Exam is geared to finding PORTAL HYPERTENSION.
    • ASCITES per se is not a sign of portal hypertension (see Ascites page for methods).
    • The Portal Vein is formed by the union of:
      • Splenic vein.
      • Superior mesenteric.
    • Therefore, SPLENOMEGALY and VENOUS PATTERNS that suggest porto-systemic anastomosis are important signs of portal hypertension.
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Written by stanford25admin

June 7, 2010 at 3:36 pm

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