Diagnosis of alcoholic liver disease

Table 4 Physical findings in alcoholic liver disease[58-67]

Spectrum of ALD	Physical examination findings
Fatty liver	Normal examination
	+/- Hepatomegaly
Alcoholic hepatitis	Jaundice
	Tender hepatomegaly
	+/- Ascites
	+/- Hepatic bruit
	Proximal muscle wasting
	Decreased grip strength
	+/- Hepatic encephalopathy (confusion, asterixis, hippus)
Cirrhosis	Spider angiomata (face, trunk, upper extremities)
	Parotid gland enlargement
	+/- Fetor hepaticus
	Gynecomastia
	+/- Hepatomegaly
	Firm liver edge with nodular contour
	+/- Splenomegaly
	Caput medusa (abdominal wall collaterals)
	Cruveilhier-Baumgarten murmur
	Testicular atrophy
	Palmar erythema
	Digital clubbing
	Muehrcke nails (paired horizontal white bands)
	Terry nails (large white proximal nail bed)
	Hypertrophic osteoarthropathy
	Dupuytren’s contracture
Decompensated cirrhosis	Cirrhotic physical finding plus:
	Jaundice
	Ascites
	Peripheral edema
	Hepatic encephalopathy (confusion, asterixis, hippus)

ALD: Alcoholic liver disease.