Portal Hypertension: 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 [jaundice (yellowing of the skin); tendency to hematoma (bruising) due to impaired clotting; hepatic skin signs:
      • Dupuytren’s contracture (synonyms: Dupuytren’s contracture, Dupuytren’s disease) – nodular, cord-like hardening of the palmar aponeurosis (tendon plate in the palm, which is the continuation of the tendon of the long palmar muscle) with an increase in the amount of coarse connective tissue, which can lead to a flexion contracture of the finger joints (fingers are forced to bend and can only be stretched again with difficulty or not at all).
      • Banknote skin (synonym: dollar bill skin) – reminiscent of banknotes, characterized by innumerable finest vascular dilatation.
      • Skin atrophy with telangiectasias (visible dilations of superficially located smallest blood vessels).
      • Lacquer lips (smooth, lacquer red lips)
      • Palmar erythema (red coloration of the palms).
      • Plantar erythema (red coloration of the soles of the feet).
      • Spider naevi (liver starlets) – small, star-shaped converging vessels on the upper body and face.
      • White nails (lunula/white area of the nail shaped like a crescent – no longer delineable)]
    • Sclera (white part of the eye) [jaundice.]
    • Oral cavity [lacquer tongue]
    • Abdomen (abdomen)
      • Shape of the abdomen?
      • Skin color? Skin texture? [“Belly baldness” (loss of body hair on abdomen)]
      • Efflorescences (skin changes)?
      • Pulsations? Bowel movements?
      • Visible vessels? [Caput medusae; Latin: head of Medusa) – visible expansion of tortuous veins (venae paraumbilicales) in the region of the navel as a result of blood stasis due to portal hypertension].
      • Scars? Hernias (fractures)?
  • Auscultation (listening) of the heart [due topossible causes:
    • Right heart failure (cardiac insufficiency)]
  • Examination of the abdomen
    • 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 to detect resistance and guarding (tenderness?, knocking pain?, coughing pain?, guarding pain?, hernial orifices?, renal bearing knocking pain?) [consistency-increased liver; meteorism; pain in right upper abdomen because of possible ascites; splenomegaly?]
  • Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation [anorectal varices].
• Health check

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