Physical examination — The physical examination may suggest the presence of liver disease and may point to the underlying cause of the liver disease.
●Temporal and proximal muscle wasting suggest longstanding disease.
●Stigmata of liver disease include spider nevi, palmar erythema, gynecomastia, and caput medusae.
●Ascites or hepatic encephalopathy may be seen in patients with decompensated cirrhosis.
●Dupuytren's contractures, parotid gland enlargement, and testicular atrophy are commonly seen in advanced alcoholic cirrhosis and occasionally in other types of cirrhosis.
●An enlarged left supraclavicular node (Virchow's node) or periumbilical nodule (Sister Mary Joseph's nodule) suggest an abdominal malignancy.
●Increased jugular venous pressure, a sign of right-sided heart failure, suggests hepatic congestion.
●A right pleural effusion, in the absence of clinically apparent ascites, may be seen in advanced cirrhosis.
●Neurologic signs and symptoms may be seen in patients with Wilson disease.