Clinical Examination for Liver and Biliary Diseases

1) Hands: Clubbing, Dupuytren's contracture, Leuconychia, Bruising, Flapping tremor (hepatic encephalopathy), Palmar erythema

2) Face: Jaundice, Spider naevi, Parotid swelling, Xanthelasma and jaundiced sclera in a patient with chronic, cholestasis, Kayser-Fleischer rings in Wilson's disease

3) Chest: Loss of body hair, Gynaecomastia, Spider naevi

4) Abdomen: Scars, Distension, Veins, Testicular atrophy, Aspiration of ascitic fluid, Dilated abdominal wall veins (caput medusae)

5) Abdomen - palpation/percussion/auscultation: Hepatomegaly, Splenornegaly, Ascites, Palpable gallbladder, Hepatic bruit (rare), Tumour

6) Legs: Bruising, Edema



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