Page 191 - Medicine and Surgery

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Chapter 5: Clinical 187

Eyes and face:
Jaundice
Xanthelasma
Parotid enlargement in alcoholism
Hepatic fetor
Chest and upper arms:
Spider naevi
Scratch marks due to pruritus
Gynaecomastia
Loss of axillary hair
Slate-grey skin in haemochromatosis
Hepatic flap

Abdomen and lower limbs: Hands:
Hepatomegaly Clubbing of the fingers
Splenomegaly Leuconychia
Ascites Palmar erythema
Testicular atrophy Dupuytren's contracture
Leg oedema

Figure 5.2 Signs of chronic liver disease.

Leuconychia – the nail appears white and opaque, but The eyes and face:

the distal end is often spared, it is thought to be due Jaundice should be looked for (see page 185).
to hypoalbuminaemia. Xanthelasma (cholesterol deposits on the eyelids) are
Palmar erythema although commonly seen in liver seen in primary biliary cirrhosis.

disease, it is also associated with pregnancy, thyrotox- Parotid enlargement occurs in alcoholism.
icosis, other diseases and may occur in healthy people. Hepatic fetor is a sweet smell of the breath, which
It has been attributed to increased levels of circulating occurs in advanced liver failure.
oestrogens, due to altered metabolism. The chest and upper arms:
Dupuytren’s contracture is a thickening of the palmar Spider naevi are telangiectases that consist of a central

fascia which may be palpable as thickening or cords arteriole with radiating small vessels. They blanch if
and as it progresses flexes the fingers (most commonly pressure is applied to the centre, then refill outwards.
the ring and little fingers). It has many causes, includ- Up to five spider naevi are said to be normal.
ing an inherited tendency, but is associated with alco- Scratch marks due to pruritus, particularly in primary
holic cirrhosis. biliary cirrhosis.