Physical exam-cirrhosis

  • Liver: initially enlarged, palpable (L lobe predom), firm; eventually shrunken, nodular

  • Signs of liver failure: jaundice (bili >2.5), spider angiomata & palmar erythema (↑ estra- diol), Dupuytren contractures, white nail lines (Muehrcke lines) & proximal nail beds (Terry nails), ↑ parotid & lacrimal glands, gynecomastia, testicular atrophy, asterixis, encephalopathy, clubbing, hypertrophic osteoarthropathy, anovulation in women

  • Signs of portal HTN: splenomegaly, ascites, dilated superficial abd veins (caput medusae), epigastric Cruveilhier-Baumgarten venous hum (flow through recanalized umbilical vein)