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Liver disease signs in the Hand


Liver disease signs in the Hand

المعلومة

Name six signs of liver disease in the hand ?

المرجع

Clinical skills for medical students-2nd edition

امرأة لا تتكرر's picture
by
السنة الخامسة


leuckonychia
palmar erythema
tremor
clubbing
xanthomas
duputren contracture

qusei

yeah , thank u dr.qusei
امرأة لا تتكرر's picture
امرأة لا تتكرر
السنة الخامسة

all of them right !
could we add another singns ??
qusei


شكرا لكما
ممكن نشوف spider angioma باليد ؟!

a.m.a's picture
a.m.a
طبيب مقيم

Quote:
ممكن نشوف spider angioma باليد ؟!

Many pregnant women, or women using OCP , have spider angiomas, due to high estrogen levels in their blood. People who have significant hepatic disease also show many spider angiomas, as their liver cannot detoxify estrogen from the blood, resulting in high levels of estrogen. About 33% of patients with cirrhosis have spider angiomas.

pic from : https://www.hakeem-sy.com/main/node/17862

Quote:
could we add another singns ??

of course all right
and yes why not

jaundice can b added to the list
wat else ?

امرأة لا تتكرر's picture
امرأة لا تتكرر
السنة الخامسة

pallor
qusei

okay ,
scratch marks from increased bile salts deposition
so yellow + itching marks

i keep spinning around jaundice

other clinical findings O/E in liver diseases :
-Oedema (secondary to hypoproteinaemia) may lead to ascites

-[=red]Gynaecomastia [/ may occur due to increased circulating oestrogen levels.

-[color=red]Parotid enlargement[/] (sialosis) may be seen in cases of cirrhosis but this is due to the associated alcohol intake rather than the cirrhosis itself.

امرأة لا تتكرر's picture
امرأة لا تتكرر
السنة الخامسة

Quote:
Gynaecomastia

occasionally unilateral

Quote:
duputren contracture

in alcoholic cirrhosis

qusei


another thing in the hand is koilonychia......when u see it go and check the mouth for glossitis and stomatitis......then u have to think of fe deficiency which might be caused by a concealed bleeding in the gi tube such as an ulcer oozing blood.....which per se might be caused by a liver disease

mbs2380's picture
mbs2380
بعد التخرج


small testes and impotence

mbs2380's picture
mbs2380
بعد التخرج

Quote:
small testes and impotence

hypogonadism is also seen in cirrhosis , caput medusa also

we can also add pigmentation of the skin if we wanted to consider iron deposition in the liver in haemochromatosis

The clinical features of liver disease are thus:

Hands : clubbing, dupuyten’s contracture,flapping tremors, koilonychia,leuconychia
Face : jaundice, spider naevi, parotid swelling, rhinophyma
Chest: loss of body hair, gynaecomastia
Abdomen : distension, testicular atrophy, dilated abdominal veins, hepatosplenomegaly, ascites. On auscultation hepatic bruit are heard.
Legs: oedema
The patient appears unkempt, smells of alcohol of fetor hepaticus, and may also have encephalopathy.

امرأة لا تتكرر's picture
امرأة لا تتكرر
السنة الخامسة

Quote:
Abdomen : distension, testicular atrophy, dilated abdominal veins, hepatosplenomegaly, ascites. On auscultation hepatic bruit are heard.
+scrach marks
Quote:
Face : jaundice, spider naevi, parotid swelling, rhinophyma

+ Xanthelasma

qusei


Let me ask you this question:
How common you see these signs in cirrhotics (what is the sensitivity) and if you don't these them does it mean cirrhosis is not there (specificity)

ABIM's picture
ABIM


petechiae and bruises can be seen on the hands of patients with liver cirrhosis due to their coagulation disorders

hodoon


koilonychia = spoon nail =celonychia
destrophy of the finger nail , in which they are thin and concave with the edges raises

some time associated with iron deficiency anemia

occurring mainly in hypoplastic anemia

قلمونية وأفتخر's picture
قلمونية وأفتخر
السنة الرابعة

Quote:
How common you see these signs in cirrhotics (what is the sensitivity) and if you don't these them does it mean cirrhosis is not there (specificity)

these S/S may occur as result of cirrhosis or its complications , they may occur in other diseases also so not necessary to see all in cirrhosis

i think .. its how we link the symptoms in a network to fit an organ dysfunction rather than ticking off from a list wats there and not

maybe the pt will make me think of cirrhosis bcuz he's coughing blood and lost lots of wt

maybe the pt comes presenting with SOB and cyanosis from hepatopulmonary syndrome as a complication

but weither i see all the S/S or not , lab test , imaging , liver biopsy are the confirmative so if i dont see them doesnt mean cirrhosis isnt there

just a point of view ..
-----

thx dr.hodoon for passing by its an honor for me
and thx dr.8alamoneya wa aft5er

امرأة لا تتكرر's picture
امرأة لا تتكرر
السنة الخامسة

Quote:
these S/S may occur as result of cirrhosis or its complications , they may occur in other diseases also so not necessary to see all in cirrhosis

add to that ,about sixty percent of cirrhotic pts are asymptomatic
so we might see these symptoms in the rest 40 % of them........this is about sensitivity

now about specificity:

Quote:
Hands : clubbing, dupuyten’s contracture,flapping tremors, koilonychia,leuconychia
Face : jaundice, spider naevi, parotid swelling, rhinophyma
Chest: loss of body hair, gynaecomastia
Abdomen : distension, testicular atrophy, dilated abdominal veins, hepatosplenomegaly, ascites. On auscultation hepatic bruit are heard.
Legs: oedema

hands:
clubbing,also seen in cardiac pts and crohn's
du contracture,also seen in amyloidosis and Dm pts

I will continue later in the evening ,sorry I have to go.........

mbs2380's picture
mbs2380
بعد التخرج


Very good
So these signs are not very sensitive and many of them are specific (palmer erythema for instance can be seen in COPD) but the more you have of these signs the more the likelihood of cirrhosis.
By the end of the day cirrhosis is defined on biopsy findings though when we have enough evidence from patient symptoms / signs and lab test them we ususally don't perform liver biopsy

ABIM's picture
ABIM
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