Asterixis on Physical Exam

Asterixis, aka liver flap, indicates at least Grade 2 hepatic encephalopathy in a patient with cirrhosis
due to a combination of 
1. Hypotonia - cannot maintain extended outstretched hands at wrist 
2. Myoclonus - fall of the hands from the extended position broken up to segments - “bat’s wing” or flapping tremors 

Dr. Martín @martinfd78 via Dr. Keith Siau @drkeithsiau

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