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General inspection
1. Well / sick
2. Jaundice
3. Pruritus (itching): scratch marks
  1. Liver disease (bile salts)
  2. Chronic renal failure
  3. Iron deficiency
  4. Drug reactions
  5. Old age
Hands
1. Clubbing:
  1. Inflammatory bowel (esp. Crohn’s disease)
  2. Cirrhosis
  3. GI lymphoma
  4. Malabsorption, e.g. coeliac
2. Dupuytren’s contracture
3. Palmar erythema: chronic liver disease
4. Liver flap^¹
5. Leukonychia – hypoalbumin
6. Koilonychia - IDA
Face
1. Jaundice
2. Pallor
Neck
1. Raised JVP: CCF / RHF, leading to hepatic damage
2. Lymph nodes: Virchow’s: stomach cancer (Troissier’s sign)
Second inspection
1. Spider naevi: >6 above nipples: chronic liver disease
2. Abdominal scars
3. Abdominal swellings
4. Gynaecomastia
Palpation
1. Quadrants – superficial and deep
2. Liver border
3. Spleen
4. Kidneys
5. Abdominal aortic aneurysm
6. Hernial orifices
Percussion
1. All quadrants – peritonitic pain + rebound tenderness
2. Liver
3. Spleen
4. Shifting dullness
Auscultation
1. Bowel sounds
2. Renal and iliac arteries
Legs
1. Erythema nodosum: red nodules, normally on shins:
  1. Liver cirrhosis
  2. Inflammatory bowel disease
Further tests:
1. DRE, proctoscopy, rigid sigmoidoscopy – consistency, blood, mucous, masses, haemorrhoids
2. MSU- urinary tract
3. Bloods: U&Es, FBC, CRP, WBC

1Encephalopathy – impaired nitrogenous waste excretion.

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by: Admin
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Word Count: 630
Date: Fri, 22 Jan 2010 Time: 3:57 PM
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