Physical exam

You perform a physical exam, and discover the following:

General appearance: Older pleasant gentleman, appearing his stated age

Vital signs: T 98.7, HR 78, BP 110/74, RR 16, O2 saturation 98% on room air

Head and neck: Icteric sclerae without jaundice; conjunctival pallor

Chest: Clear to auscultation; breathing comfortably on room air

CVS: S1, S2, no extra heart sounds, no murmurs

Abdomen: Soft, nontender, nondistended; no organomegaly

CNS: Alert and oriented; no focal deficits in strength or sensations

Lymph: No palpable cervical or supraclavicular lymphadenopathy

While performing a careful exam of his extremities, you observe the findings shown in the two images below:

You noted scleral icterus on this patient’s exam, and he reported prior alcohol use to you. His wife is concerned about cirrhosis. Which exam findings would concern you for cirrhosis?

a
Hepatosplenomegaly
b
Palmar erythema
c
Spider angiomata
d
Caput medusae
e
Gynecomastia

Findings of chronic liver disease are absent on his exam.

Interested in further reading? Refer to the Stanford Medicine page on physical exam findings in liver disease.

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