Portal hypertension physical examination
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Portal hypertension physical examination On the Web
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Physical examination of patients with portal hypertension is usually remarkable for splenomegaly, caput medusae, and thrombocytopenia. The presence of jaundice on physical examination is highly suggestive of cirrhosis. Patients with portal hypertension usually appear ill and icteric.
- Patients with portal hypertension are usually asymptomatic at early stages of the disease.
- Physical examination of patients with portal hypertension is usually remarkable for splenomegaly, caput medusae, and thrombocytopenia.
- The presence of jaundice on physical examination is highly suggestive of cirrhosis.
Appearance of the Patient
- Patients with portal hypertension usually appear ill and icteric.
- Low-grade fever
- High-grade fever in spontaneous bacterial peritonitis (SBP)
- Tachypnea in congestive heart failure (CHF)
- Bounding pulse
- Arterial hypotension
- Abdominal distention in ascites
- Shifting dullness in ascites
- Abdominal tenderness in all abdominal quadrants due to SBP
- Rebound tenderness (positive Blumberg sign) in SBP
- Guarding may be present in SBP
- Dilated veins on abdominal wall, suggestive of umbilical epigastric vein shunts
- Venous patterns on the flanks, suggestive of parieto-portal shunts
- Caput medusae, i.e. tortuous paraumbilical collateral veins
- Paraumblical hernia
- Venous hums
- Dupuytrens contracture
- Muscle wasting in cirrhosis
- Palmar erythema in cirrhosis
- Leukonychia in cirrhosis
- Asterixis in hepatic encephalopathy
- Pitting edema of the lower extremities
- (http://cnx.org/content/m14900/latest/) [<"http://creativecommons.org/licenses/by/2.0">CC BY 2.0], <"https://commons.wikimedia.org/wiki/File%3ASpider_nevus.jpg">via Wikimedia Commons
- Hou W, Sanyal AJ (2009). "Ascites: diagnosis and management". Med. Clin. North Am. 93 (4): 801–17, vii. doi:10.1016/j.mcna.2009.03.007. PMID 19577115.
- Escorsell A, Garcia-Pagán JC, Bosch J (2001). "Assessment of portal hypertension in humans". Clin Liver Dis. 5 (3): 575–89. PMID 11565131.