Cirrhosis
Demographics: Most common in heavy alcohol consumption or individuals with Hepatitis C (HHS, 2008). Other factors include obesity, fatty liver disease, autoimmune disease, inherited diseases such as cystic fibrosis and drugs or other forms of toxins.
Clinical Presentation (Ferrell, 2000; HHS, 2008, Goodman & Snyder, 2007): Signs and symptoms include upper right quadrant pain, jaundice, anorexia, indigestion, weight loss, impotence, bleeding gums, edema in the lower extremities, nausea, vomiting, diarrhea, constipation, dull abdominal ache, ascites, spider angiomas, skin or nail changes, bilateral carpal tunnel, fatigue, weakness and fever.
Differential Diagnosis: A thorough patient history, with focus on reviewing all red flags and constitutional signs and symptoms to check for systemic illness. Questions should also include alcohol consumption. Examination should also include palpation of the liver, observation for ascites, jaundice (skin and eyes), redness of the palms, test for asterixis and checking for carpal tunnel bilaterally (Goodman & Snyder, 2007). Positional testing should be performed to rule out musculoskeletal involvement.
Bottom Line: Refer out
When symptoms begin to present themselves, it is a sign of serious liver involvement. If cirrhosis of the liver is suspected, it should warrant immediate physician referral.
Clinical Presentation (Ferrell, 2000; HHS, 2008, Goodman & Snyder, 2007): Signs and symptoms include upper right quadrant pain, jaundice, anorexia, indigestion, weight loss, impotence, bleeding gums, edema in the lower extremities, nausea, vomiting, diarrhea, constipation, dull abdominal ache, ascites, spider angiomas, skin or nail changes, bilateral carpal tunnel, fatigue, weakness and fever.
Differential Diagnosis: A thorough patient history, with focus on reviewing all red flags and constitutional signs and symptoms to check for systemic illness. Questions should also include alcohol consumption. Examination should also include palpation of the liver, observation for ascites, jaundice (skin and eyes), redness of the palms, test for asterixis and checking for carpal tunnel bilaterally (Goodman & Snyder, 2007). Positional testing should be performed to rule out musculoskeletal involvement.
Bottom Line: Refer out
When symptoms begin to present themselves, it is a sign of serious liver involvement. If cirrhosis of the liver is suspected, it should warrant immediate physician referral.