Hepatic Insufficiency: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

• General physical examination – including blood pressure, pulse, body weight, height; further:
  • Inspection (viewing).
    • Skin, mucous membranes, oral cavity, and sclera (white part of the eye) [jaundice (jaundice); foetor hepaticus (specific breath odor (of raw liver)); flapping tremor (flutter tremor; coarse hand tremor)]
    • Abdomen (abdomen)
      • Shape of the abdomen?
      • Skin color? Skin texture?
      • Efflorescences (skin changes)?
      • Pulsations? Bowel movements?
      • Visible vessels?
      • Scars? Hernias (fractures)?
  • Auscultation (listening) of the heart.
  • Auscultation of the lungs
  • Examination of the abdomen (belly)
    • Percussion (tapping) of the abdomen
      • Ascites (abdominal fluid): phenomenon of fluctuation wave. This can be triggered as follows: if you tap against one flank a wave of fluid is transmitted to the other flank, which can be felt by placing the hand (undulation phenomenon); flank attenuation.
      • Meteorism (flatulence): hypersonoric tapping sound.
      • Attenuation of the tapping sound due to enlarged liver or spleen, tumor, urinary retention?
      • Hepatomegaly (liver enlargement) and/or splenomegaly (spleen enlargement): estimate liver and spleen size.
    • Palpation (palpation) of the abdomen (abdomen), etc., with an attempt to palpate the liver (tenderness?, tapping pain?, coughing pain?, defensive tension?, hernial ports?, kidney bearing tapping pain?) [due topossible causes or differential diagnoses:
      • Hepatitis (inflammation of the liver), unspecified.
      • Cirrhosis (connective tissue remodeling of the liver associated with functional impairment)]
• If necessary, gynecological examination in existing pregnancy [due topossible causes or differential diagnoses:
  • HELLP syndrome (H = hemolysis, E = elevated liver enzymes, LP = low platelets) – special form of preeclampsia, which is associated with blood count changes and can take life-threatening courses/complication of gestational hypertension.
  • Fatty liver of pregnancy]
• Neurological examination [due topossible symptom: hepatic encephalopathy (HE, synonyms: portosystemic encephalopathy, hepatoportal encephalopathy, minimal encephalopathy; it is a potentially reversible brain dysfunction resulting from inadequate detoxification function of the liver); symptoms may include: Impaired consciousness, euphoria, depression, insomnia (sleep disturbances), confusion][due topossible sequelae:
  • Encephalopathy (disease or damage to the brain).
  • Cerebral edema (swelling of the brain)]
• Urological/nephrological examination [due topossible symptom: hepatorenal syndrome (renal insufficiency/renal failure due to liver failure)][due topossible sequelae: acute renal failure (hepatorenal syndrome)]
• Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.