Physical examination of patients with acute HDV infection may be normal, or include findings, such as jaundice, and some degree of impairment of joint movement due to arthralgia. Physical examination of patients with chronic disease, depending on the its stage, may include: jaundice; palmar erythema; spider angiomata;gynecomastia; hepatomegaly; splenomegaly; ascites; peripheral edema; and asterixis.

The aim of the initial physical examination is to observe for the presence of signs of chronic liver disease which include the following:^[1]

• Jaundice
• Palmar erythema
• Spider angiomata
• Gynecomastia

• Icterus

• Hepatomegaly
• Shrunken liver
• Splenomegaly
• Ascites
• Caput medusae

• Peripheral edema
• Dupuytren’s contracture

• Asterixis
• Neurologic manifestations in cases of HBV progression to hepatic encephalopathy include a wide spectrum of cognitive impairment and motor system abnormalities.^[2]

• Arthritis-dermatitis syndrome:^[3]
  • Urticaria
  • Petechiae
  • Palpable purpura
  • Arthralgia
  • Arthritis of small joints
• Neuropathy

Refer to the cirrhosis image gallery for images of the physical findings listed above.