Case 5 – Jaundice

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


  • 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