Liver Shrinkage (Cirrhosis): Examination

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

  • General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore:
    • Inspection (viewing).
      • Skin, mucous membranes, with attention to skin (liver skin signs) and mucous membrane color and hydration status [jaundice (yellowing of the skin); melanosis (slowly progressive darkening of the skin); tendency to hematoma (bruising) due to impaired clotting; itching; Peripheral edema (accumulation of water in the tissues of the legs); spider naevi (hepatic asterisks; small vessels that converge in a star shape); loss of body hair in males; virilization (masculinization occurring in females); xanthelasmata (fatty deposits around the skin of the eyes)]
      • Sclerae (white part of the eye) [jaundice.]
      • Oral cavity [lacquer lips, lacquer tongue]
      • Extremities [palmar erythema (red coloration of the palms); drumstick fingers (fingers distended at the end links); white nails; xanthomas (fatty deposits on the joints); plantar erythema (red coloration of the soles of the feet)]
      • Abdomen (abdomen)
        • Shape of the abdomen?
        • Skin color? Skin texture?
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels? – Caput medusae (lat. : head of Medusa; varices (visible extension of tortuous veins) in the region of the navel – due to bypassing of the hepatic stroma via the portocaval anastomosis present in the skin veins of the umbilical region (venae paraumbilicales) – as a result of blood stasis due to portal hypertension (portal hypertension)).
        • Scars? Hernias (fractures)?
    • Auscultation (listening) of the heart [due topossible causes:
      • Chronic right heart failure (cardiac insufficiency).
      • Pericarditis constrictiva (chronic pericarditis with shrinkage of the pericardium and consequent limitation of cardiac function)]
    • Auscultation of the lungs [due topossible secondary disease: hepatopulmonary syndrome (lung damage due to liver cirrhosis with unclear origin)]
    • In man:
      • Inspection and palpation (palpation) of the mammary glands [gynecomastia (enlargement of the mammary gland in men)].
      • Inspection and palpation of the genitals (penis and scrotum (scrotum); assessment of testicular position and size (if necessary by orchimeter); if necessary, the painfulness compared to the opposite side or where is the punctum maximum of pain) [testicular atrophy (shrinkage of the testis)]
    • Examination of the abdomen (abdomen) [liver: often enlarged, possibly hardened and bumpy].
      • Auscultation (listening) of the abdomen [vascular or stenotic sounds?, bowel sounds?]
      • 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 of the abdomen (belly), etc., to detect resistance and defensive tension (pressure pain?, knocking pain?, coughing pain?, defensive tension?, hernial ports?, kidney bearing knocking pain?) [consistence increased liver; meteorism (flatulence); pain in the right upper abdomen][due topossible differential diagnosis: hepatitis (liver inflammation), unspecified][due topossible sequelae:
    • Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation, including inspection of the anal region [hemorrhoidal disease (hemorrhoids)?]
  • Cancer screening [due todifferential diagnosis or possible secondary disease: hepatocellular carcinoma (liver cancer)]
  • Gynecological examination [wg.possible symptom: cycle irregularities such as oligomenorrhea (menstruation too infrequent: the interval between bleeding is > 35 days and ≤ 90 days) to amenorrhea (absence of menstruation; > 90 days)].
  • Neurological examination [due topossible symptom: restless legs syndrome][due topossible sequelae: hepatic encephalopathy (pathological, non-inflammatory change in the brain due to severe liver dysfunction)]
  • Psychiatric examination [due topossible symptoms:
    • Mental instability
    • Sleep disturbances]

    [due topossible cause: alcohol dependence]

  • Urological examination [due topossible symptom: loss of potency][due topossible sequelae: hepatorenal syndrome (severe renal dysfunction due to liver cirrhosis)]
  • Health check

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