Symptoms |
Anorexia |
Weight loss |
Weakness |
Fatigue |
Muscle cramps |
Easy bruising |
Amenorrhea/oligomenorrhea/metrorrhagia (women) |
Impotence (men) |
Infertility |
Decreased libido (men) |
Jaundice* |
Dark or "cola-colored" urine* |
Pruritus* |
Hematemesis/melena/hematochezia* |
Abdominal distension* |
Lower extremity edema* |
Confusion or sleep disturbances* |
Physical examination |
Hepatomegaly |
Splenomegaly |
Spider angiomata/spider telangiectasias |
Palmar erythema |
Digital clubbing |
Hypertrophic osteoarthropathy |
Dupuytren's contracture |
Muehrcke nails |
Terry nails |
Parotid gland enlargement (likely due to alcohol use and not cirrhosis per se) |
Gynecomastia (men) |
Loss of chest or axillary hair (men) |
Testicular atrophy (men) |
Caput medusa |
Cruveilhier-Baumgarten murmur (venous hum heard best with the stethoscope over the epigastrium) |
Jaundice* |
Ascites (abdominal distension, shifting dullness, fluid wave)* |
Asterixis* |
Fetor hepaticus* |
Laboratory tests |
Moderately elevated aminotransferases (often with an AST:ALT ratio >1) |
Elevated alkaline phosphatase (2 to 3 times the ULN) |
Elevated gamma-glutamyl transpeptidase |
Thrombocytopenia |
Leukopenia/neutropenia |
Anemia |
Low serum albumin* |
Prolonged prothrombin time/elevated INR* |
Hyperbilirubinemia* |
Hyponatremia* |
Elevated serum creatinine* |
Imaging tests |
Surface nodularity |
Increased echogenicity (ultrasound) |
Atrophy of the right lobe |
Hypertrophy of the caudate or left lobes |
Small, nodular liver* |
Ascites* |
Hepatocellular carcinoma* |
Portal/splenic/superior mesenteric vein thrombosis* |
Portosystemic collaterals* |
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