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•   100 Cases
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Diagnosis:

Chronic liver disease & hepatomegaly

Area to examine ?

Abdomen

Lymph nodes

Examine parotid gland

Look for hair loss, spider naevi and gynecomastia 

Clinical signs:

Signs of chronic liver disease:

General: Jaundice, excoriation, brusing

Hands: leuconychia, clubbing, dupuytren’s contractures and palmar erythema

Face: xanthelasma, parotid swelling and fetor hepatics

Chest & abdomen: spider naevi, caput medusa, reduced body hair, gynecomastia and testicular atrophy

• Most observed 

Evidence of decompensation

Ascites

Asterixis

Altered consciousness 

Differential diagnosis of hepatomegaly:

Cirrhosis

Cancer

Congestive heart failure

Infectious like HBV & HCV

Immune like PBC, PSC & AIH

Amyloid & myeloprofilerative disorders

What will you do ?

Basic profile CBC, LFT, RFT, glucose, …

U/S abdomen

Hepatitis B surface antigen & C antibody

Hepatic synthetic function : INR ( acute ) & Albumin ( chronic )

Liver biopsy

ERCP for PSC

Paracentesis ( Tap ) for ascites

A-1 antitrypsin

Ceruplasmin for wilson’s disease

Ferritin for hemochromatosis

Antimitochondrial antibody & IgM for PBC

ANA, anti-smooth muscle antibody, anti-liver/kidney microsomal type 1 antibody

For malignancy need CXR, Pan CT, endoscopy , colonoscopy and biopsy