Peripheral Stigmata of Liver Disease

1. Liver Failure - some exam findings to look for include:

• encephalopathy
• asterixis
• jaundice
• bruising
• fetor hepaticus
• muscle wasting
• clubbing (read more here)

2. High Estrogen states associated with liver disease, look for:

• palmar erythema
• spider nevi (these blanch)
• gynecomastia
• feminization of body hair
• testicular atrophy

3. For underlying clues as to the etiology of liver disease, look for:

• duputryen's contractures - alcohol
• keiser fleischer rings - Wilson's disease
• 'bronzed' complexion - iron overload syndromes (hemochromatosis)
• track marks - IV drug use, and perhaps underlying Hepatitis C.

4. Also look for signs of portal hypertension, which include:

• ascites and pedal edema (previously posted here and here)
• distended abdominal veins
• caput medusa
• splenomegaly

Below: duputrene's contracture, palmar erythema, and spider angioma