Question

Delineate assessment findings for: Fatty liver and Cirrhosis.

Answer 1

To make a diagnosis, your doctor will use

• Your medical history
• A physical exam
• Various tests, including blood and imaging tests, and sometimes a biopsy

As part of the medical history, your doctor will ask about your alcohol use, to find out whether fat in your liver is a sign of alcoholic fatty liver disease or nonalcoholic fatty liver (NAFLD). He or she will also ask which medicines you take, to try to determine whether a medicine is causing your NAFLD.

During the physical exam, your doctor will examine your body and check your weight and height. Your doctor will look for signs of fatty liver disease, such as

• An enlarged liver
• Signs of cirrhosis, such as jaundice, a condition that causes your skin and whites of your eyes to turn yellow

You will likely have blood tests, including liver function tests and blood count tests. In some cases you may also have imaging tests, like those that check for fat in the liver and the stiffness of your liver. Liver stiffness can mean fibrosis, which is scarring of the liver. In some cases you may also need a liver biopsy to confirm the diagnosis, and to check how bad the liver damage is.

Cirrhosis

• Physical examination of patients with cirrhosis is usually remarkable for: jaundice, spider angiomata, ascites, asterixis, spleenomegaly and palmar erythema.

Appearance of the patient

• Patients with cirrhosis usually appear weak due to constitutional symptoms such as weight loss, anorexia and muscle atrophy. Yellowish discoloration of skin and abdominal distension may also be present due to ascites.

• Normal/low blood pressure with normal pulse pressure.

Skin

• Jaundice : yellow discoloration of the skin, eyes, and mucus membranes due to increased bilirubin (at least 2-3 mg/dL or 30 mmol/L). Urine may also appear dark.
• Pallor
• Bruises
• Palmar erythema on the thenar and hypothenar eminences, due to altered sex hormone metabolism.
• Spider angiomata: Increased estradiol levels lead to the formation of vascular lesions consisting of central arterioles surrounded by smaller vessels [1]
• Telangiectasias or spider veins: small dilated blood vessels near the surface of the skin.

• HEENT

  • Abnormalities of the head/hair may include thinning of hair on the scalp due to hyperestrogenism
  • Kayser-Fleischer rings: dark rings that appear to encircle the iris of the eye in patients with Wilson's disease[3]
  • Parotid gland enlargement
  • Fetor hepaticus: severe portal-systemic shunting leads to increased levels of dimethyl sulfide leads to a sweet pungent smell in the breath
  

  Liver Cirhhosis
  Source: Wikimedia commonAbdomen

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