CC: jaundice or weight loss
Diagnosis:
Chronic liver disease & hepatomegaly
Area to examine ?
Abdomen
Lymph nodes
Examine parotid gland
Look for hair loss, spider naevi and gynecomastia
Clinical signs:
Signs of chronic liver disease:
General: Jaundice, excoriation, brusing
Hands: leuconychia, clubbing, dupuytren’s contractures and palmar erythema
Face: xanthelasma, parotid swelling and fetor hepatics
Chest & abdomen: spider naevi, caput medusa, reduced body hair, gynecomastia and testicular atrophy
• Most observed
Evidence of decompensation
Ascites
Asterixis
Altered consciousness
Differential diagnosis of hepatomegaly:
Cirrhosis
Cancer
Congestive heart failure
Infectious like HBV & HCV
Immune like PBC, PSC & AIH
Amyloid & myeloprofilerative disorders
What will you do ?
Basic profile CBC, LFT, RFT, glucose, …
U/S abdomen
Hepatitis B surface antigen & C antibody
Hepatic synthetic function : INR ( acute ) & Albumin ( chronic )
Liver biopsy
ERCP for PSC
Paracentesis ( Tap ) for ascites
A-1 antitrypsin
Ceruplasmin for wilson’s disease
Ferritin for hemochromatosis
Antimitochondrial antibody & IgM for PBC
ANA, anti-smooth muscle antibody, anti-liver/kidney microsomal type 1 antibody
For malignancy need CXR, Pan CT, endoscopy , colonoscopy and biopsy
