Physical Exam Findings
Complications
Yes or No
Fun Facts
100
This yellow discoloration of the eyes is caused by elevated bilirubin. What clinical feature is this?
Jaundice
100
What is this?
Dilated veins in the esophagus that can rupture and cause massive bleeding.
Esophageal varices
100
Chronic Liver Disease? 
Yes.
Ascites
200
These small, red, spider-like blood vessels on the chest are associated with chronic liver disease. What are these called?
Spider Angiomas
200
What is this?
Confusion and altered mental status due to buildup of toxins like ammonia.
Hepatic Encephalopathy
200
Chronic Liver Disease?
A patient with yellow eyes for 2 days after food poisoning.
No acute liver issues.
Jaundice is associated with chronic liver disease too. Has a longer timeline and is due to structural failure, often cirrhosis, and loss of capacity.
300
What is this?
Asterixis.
Often caused by liver disfunction -> impaired urea cycle -> ammonia buildup
300
What is this?
Low platelet count in cirrhosis is often due to enlargement of this organ.
Spleen
Portal hypertension -> splenomegaly -> abnormal sequestration of platelets
300
Chronic Liver Disease?
A patient with heavy alcohol use for 20 years and low platelets.
Yes, likely chronic liver disease.
400
What is this?
Ascites.
Fluid accumulation due to portal hypertension, can be detected with shifting dullness.
400
Bruising easily in cirrhosis is due to reduced production of these proteins. Which clotting factors are produced by the liver?
All of them are produced by the liver* :)
*VIII and III are special. VIII is produced mainly in endothelial cells lining liver sinusoids. Then its packaged and stored in Weibel Palade bodies.
But tomato to-mato.
400
Chronic Liver Disease?
A patient with kidney disease and low albumin in the urine.
No. Not Chronic Liver Disease.
Likely nephrotic syndrome.
500
What is this?
Palmar Erythemia.
Cirrhosis -> chronically damaged liver -> elevated hormone levels because liver cannot metabolize them (estrogen) -> increased nitric oxide -> increased vascular dilation
500
A patient with long-standing alcohol use presents with weight loss, early satiety, abdominal distension, and fatigue. This symptom contributes to his declining nutritional status.
Loss of appetite.
Appetite drops because:
- Chronic inflammation
- Altered metabolism
- Ascites causing early satiety
- Cytokine changes
- Toxin buildup
500
Chronic Liver Disease?
AST and ALT greater than 1000 in a previously healthy patient.
No.
More consistent with acute hepatitis.
Chronic is often midly elevated 2-5x upper limit of normal. Rarely above 300-400.
500
Is pruritus a symptom of chronic liver disease? Y/N
Yes. It can be. Not as often as ascites. There is often impaired bile flow when there is pruritic symptoms.
Bile acids impaired from getting out -> accumulate in blood stream -> deposit in skin -> skin nerve irritation -> pruritus.