Gastrointestinal varices physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Physical examination of patients with gastrointestinal varices is usually remarkable for ascites, pallor, jaundice, tachycardia, low blood pressure in case of shock, hepatomegaly or shrunken liver (in case of cirrhosis), spleenomegaly, altered mental status, palmar erythema, cyanosis and clubbing.

Physical examination of patients with gastrointestinal varices is usually remarkable for the following findings:

• Patients with gastrointestinal varices due to chronic liver disease usually appear weak and disoriented. Patient may have pallor if there is active bleeding from varices

• Tachycardia
• Low blood pressure in case of shock due to severe bleeding from ruptured varices

• Tachycardia with bounding pulses
• Tachypnea in case of hepatopulmonary syndrome

• Jaundice
• Pallor

• Pallor in conjunctiva and cyanosis of the tongue, lips, and peripheries, due to low oxygen saturation
• Telangiectasis of the lips

• Lymphadenopathy incase of lymphoma

• S1 and S2 positive
• Chest examination may reveal gynecomastia in males from failure of liver to metabolize estrogen (normally occurs in the liver)

• Abdominal distention due to ascites
• Dilated veins in the anterior abdominal wall
• Caput medusae (tortuous paraumbilical collateral veins)
• Hepatomegaly / splenomegaly
• Paraumbilical hernia
• Liver may be shrunken in case of cirrhosis

• Testicular atrophy in males
• Rectal hemorrhoids
• Tarry stools filling the rectal vault on rectal exam

• Patient may be disoriented to time, person or place in case of hepatic decompensation
• Altered mental status
• Asterixis

• Clubbing
• Cyanosis
• Dupuytren contracture
• Muscle wasting
• Palmar erythema and leukonychia