Alcoholic liver disease physical examination

There are certain stigmata associated with alcoholic liver disease that one should look for on physical examination. These include; jaundice, gynecomastia, spider angiomata, bruising, hepatosplenomegaly, ascites, testicular atrophy, asterixis, and palmar erythema. A thorough neurologic and mental status exam should also be done to assess for signs of hepatic encephalopathy, or other neurologic deficits that may be caused by chronic alcohol use.

Physical examination of alcoholic liver disease includes:^{[1][2][3][4][5][6][7][8][9][10]}

• Fever may be present

• Fetor hepaticus (breath smelling like a freshly opened corpse)
• Parotid hypertrophy
• Poor dentition
• Scleral icterus

• Jaundice
• Abnormal dark or light patches of skin
• Spider angiomata
• Gynecomastia
• Bruising or other indications of thrombocytopenia
• Striae

• Hepatosplenomegaly
• Abdominal distention
• Palpable liver edge
• Abdominal tenderness
• Ascites
• Fluid wave (due to ascites)
• Right upper quadrant tenderness

• Testicular atrophy

• Muscle atrophy
• Asterixis
• Palmar erythema

• Confusion, coma (encephalopathy) may be present
• Evidence of Wernicke’s or Korsakoff’s syndrome

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