You are seeing Mr. Jamison, a 45 year old known alcoholic, in the ER because he states that his skin color has recently changed. Please perform a focused physical examination.
Physical Examination
Inspection
- Comments on overall appearance
- Comments on proximal and temporal muscle wasting
- Examines sclera, frenulum, and skin for icterus
- Examines upper thorax, neck, and head for spider nevi
- Examines abdomen for caput medusa
- Examines for asterixis
Examination of the hands
- Examines for nail changes
- Examines for flexion contractures
- Comments on palmar erythema
- Examines for thenar muscle wasting
Examination of the Abdomen
- Estimates liver span using palpation and percussion
- Comments on size and texture of the liver
- Palpates for splenomegaly
- Percusses in Traube’s Space
- Percusses for Castell’s Sign
Examination for Ascites
- Comments on presence of bulging flanks from the foot of the bed
- Percusses abdomen for presence of ascites
- Examines for Shifting Dullness (positive)
- Performs Fluid Wave Test (positive)
Case 5 – Jaundice