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A liver biopsy is the only definitive test that
actually indicates whether or not you have cirrhosis [irreversible
scaring of the liver]. So, what exactly is your doctor looking for
when he/she does a physical exam? Are there actually some physical
clues that suggest that you have cirrhosis? The answer to this
question is yes.
The following is a list of 19 clues that indicate that you may
already have cirrhosis. These are listed alphabetically by their
common medical name. It is important to remember that, although
helpful, each of these physical manifestations do not indicate the
actual cause of one's liver disease, and, in fact, are not specific
only to liver disease. They can be due to other disorders as
- ASCITES: An accumulation of excess fluid in the abdomen. Causes
abdominal distention. Can be treated with a low sodium diet, and
the use of diuretics, i.e. water pills.
- ASTERIXIS: An uncontrollable flapping of the hands that becomes
noticeable when patients stretch out their arms, palms out, as if
stopping traffic. Is associated with mental confusion, i.e.
- CAPUT MEDUSA: Enlarged blood vessels that snake out from the
belly button in a patient with ascites.
- DUPUYTREN'S CONTRACTURE: A puckering of the palms that prevents
people from totally straightening out their hand. Usually
associated with alcoholic liver disease.
- EDEMA: Fluid accumulation in the legs, especially the ankles.
Usually associated with ascites.
- ENCEPHALOPATHY: An altered mental status leading to coma. Can
be treated with animal protein restriction and a poorly absorbed
sugar called Lactulose.
- FETOR HEPATITICUS: A particularly foul "dead mouse" smell found
on the breath. Frequently precedes coma.
- GYNECOMASTIA: Enlarged, tender breasts in men. Commonly
associated with alcoholic cirrhosis, but may also be due to
Aldactone, a drug used to control ascites.
- HAIR LOSS: Hair becomes sparce in men from the face, chest and
pubis, and under the arms in women.
- JAUNDICE: A yellow discoloration of the skin due to an elevated
- MUSCLE WASTING: Loss of muscle mass, seen in end-stage
cirrhosis when the liver can no longer manufacture proteins.
- PALMAR ERYTHEMA: Bright red coloring of the palms, particularly
at the base of the thumb and little finger. May be due to excess
- PAPER MONEY SKIN: Numerous small blood vessels that resemble
the silk threads in a U.S. dollar bill. Commonly cover the upper
- PAROTID GLAND ENLARGEMENT: Enlargement of a gland on the face
located under the ear. Causes an unusual appearance of the
protrusion of the earlobes straight out from the jaw.
- SCLERAL ICTERUS: Yellow discoloration of the whites of the eyes
[sclera], due to an elevated bilirubin level.
- SPIDER ANGIOMATA: Enlarged blood vessels that resemble little
spiders. Usually found on the upper chest,back, face, and arms.
Turn white when their center is touched [blanches]. More common in
- SUBACUTE BACTERIAL PERITONITIS: Fever, and abdominal pain in a
patient with ascites.
- TERRY'S NAILS: The normal pinkish color of the nails turns
completely white, with the disappearance of the half-moon circles
at the base of the nails.
- UMBILICAL HERNIA: Protrusion of the belly button [umbilicus],
in a patient with massive ascites.
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