2012-9-27 Clinical Features Jaudice oration of skin, Com membranes insufficiency hypertension trunk and face degradation in liver hard surface on Splenomegaly pertension Palmar erythema Proteinaceous fluid in dusa Cruveilhier- A variety of metabolic from umbilicus vein that shunts blood Epigastric vascular andular male breast pattern tissue oestradiol, yndrome erythemia entral portion of th ed oestradiol orizonal white bands Hypoalbuminaemia oxime white t Foetor hepaticus swe ubad aons of disinhitonof motor afa atile dimethylsulfide, Hypertrophic Painful proliferative Hypoxaemia due to right-to- especially in portosyst Anorexia, fatigue, Occurs in >50% of steoarthropathyfing osteoarthropathy of ed liver, secondary to ibrosis and chanced oxidative stress Type 2 diabetes Occurs in of Catabolic metabolism by ontraction of palmar patients with cirrhosis diseased liver, secondary to 腱膜桡侧字缩 fascia exposure or diabeties) Clinical features( Hepatocellular Insufficiency -Reduced synthesis of coagulation factors(Il,V,VIL, IX, X Hypersplenism: low platelet count, poor absorption Gastrointestinal bleeding Hormonal abnormalities Gynecomastia Spider nevi Jaundice 102012-9-27 10 Clinical Features  Jaundice  Edema  Coagulopathy  Spider angiomata  Palmar erythema  A variety of metabolic abnormalities  Gastroesophageal varices  Splenomegaly  Ascites  Hepatic encephalopathy  Caput medusae, Cruveihier￾Baumgarten syndrome hepatocellular insufficiency portal hypertension Description Cause Jaudice Yellow discoloration of skin, cornea, and mucous membranes Compromised hepatocyte excretory function, occurs when serum bilirubin>20mg/L Spider amgiomata Central arteriole with tiny radiating vessels, mainly on trunk and face Raised oesotradiol, decreased oestradiol degradation in liver Nodular liver Irregular, hard surface on palpation Fibrosis, irregular regeneration Splenomegaly Enlarged on palpation or in ultrasound Portal hypertension, splenic congestion Ascites Proteinaceous fluid in abdominal cavity, clinical detected when≥1.5L Portal hypertension Caput medusae Prominent veins radiating from umbilicus Portal hypertension, reopening of umbilical vein that shunts blood from portal vein Cruveilhier￾Baumgarten syndrome Epigastric vascular murmur Shunts from portal vein to umbilical vein branches, can be present without Caput medusae Palmar erythemia Erythema sparing central portion of the palm Increased oestradiol, decreased oestradiol degradation in liver White nails Horizonal white bands or proximal white nail plate Hypoalbuminaemia Hypertrophic Painful proliferative Hypoxaemia due to right-to￾left shunting Osteoarthropathy/fing er clubbing Osteoarthropathy of long bones Portopulmonary hypertension Dupuytren’s contracture 掌腱膜桡侧挛缩 Fibrosis and contraction of palmar fascia Enhanced oxidative stress, increased inosine (alcohol exposure or diabeties) Gynecomastia, loss of male hair pattern Benign proliferation of glandular male breast tissue Enhanced conversion of androstenedione to oestrone and oestradiol, reduced oestradiol degradation in liver Hypogonadism Mainly in alcoholic cirrhosis and haemochromatosis Direct toxic effect of alcohol or iron Flapping tremor (asterixis) Asynchronous flapping motions of dorsiflexed hands Hepatic encephalopathy, disinhibition of motor neurons Foetor hepaticus Sweet, pungent smell Volatile dimethylsulfide, especially in portosystemic shunting and liver failure Anorexia, fatigue, weight loss, muscle wasting Occurs in >50% of patients with cirrhosis Catabolic metabolism by diseased liver, secondary to anorexia Type 2 diabetes Occurs in 15-30% of patients with cirrhosis Catabolic metabolism by diseased liver, secondary to anorexia  Tendency to hemorrhage and anaemia --Reduced synthesis of coagulation factors (II,V,VII,IX,X) -- Hypersplenism: low platelet count, poor absorption -- Gastrointestinal bleeding  Hormonal abnormalities -- Gynecomastia -- Telangiectases -- Spider nevi -- Palmar erythema  Jaundice Hepatocellular Insufficiency Clinical features (I) spider nevi