Clinical picture of liver cirrhosis and peripheral stigmata:-
Schuppan D and Afdhal N 2008 illustrated many associated features of liver cirrhosis as follow
Jaundice :- occurs when serum bilirubin >2 mg/dl l due to hepatocyte dysfunction to handle bilirubin excretion
Spider angiomata:- central arteriole with tiny radiating vessels, mainly on trunk and face due to increase level of estrogen as decrease its hepatic degradation
Splenomegaly due to Portal hypertension, leading to splenic congestion
Ascites :- detected clinically when when ≥1.5 L as a result of Portal hypertension and hypoalbunemia
Caput medusae :- obvious veins veins radiating from umbilicus due to portal hypertension, reopen umbilical vein
Cruveilhier Baumgarten syndrome:-vascular murmur over umbilicus caused by Shunts from portal vein to umbilical vein branches.
Palmar erythema : increase estradiol estradiol due to decrease its degradation by liver.
White nails :- Horizontal white bands over nails due to hypoalbuminemia 20
Hypertrophic osteoarthropathy and Finger clubbing :- of long bones you can find Painful proliferative osteoarthropathy due to hypoxemia from right to left shunting and porto-pulmonary hypertension
Dupuytren’s contracture :- palmer fascia contraction from fibrous tissue formation caused by elevated hypoxanthine (alcohol or diabetes)
Gynecomastia, loss of hair pattern in men :- as a result of proliferation of glandular male breast tissue due to increase conversion of androstenedione to estrone and estradiol, and decreased hepatic estradiol degradation.
Hypogonadism :- especially in cases of alcoholism and hemochromatosis.
Flapping tremor (asterixis) :- dorsi flexed hands tremors due to Hepatic encephalopathy,
Foetor hepaticus :- Sweet smell from dimethylsulfide in portosystemic shunting and liver failure.
Reference:
Schuppan D and Afdhal N 2008. Liver cirrhosis. Lancet. Mar 8; 371(9615): 838–851.