(1/8) We're back again with another #Back2Bedside tweet! This time we take on "Cirrhosis". What physical exam findings are the most useful? And what is the evidence behind them?
๐งต A tweetorial
@michellebr00ks @vcuhospitalmed @AndreMansoor @ptfaddenMD @Bedsidemedicine
๐งต A tweetorial
@michellebr00ks @vcuhospitalmed @AndreMansoor @ptfaddenMD @Bedsidemedicine
(2/8)Jaundice:
- Clinically detected at 3mg/dl but sensitivity increases to 83% when bilirubin > 10mg/dl & 96% when >15mg/dl
- Scleral icterus is a misnomer! It is actually the conjunctiva that is involved. Different from patients with carotenemia where conjunctiva are spared
- Clinically detected at 3mg/dl but sensitivity increases to 83% when bilirubin > 10mg/dl & 96% when >15mg/dl
- Scleral icterus is a misnomer! It is actually the conjunctiva that is involved. Different from patients with carotenemia where conjunctiva are spared
(3/8) Ascites:
- Detected through 4 common physical exam signs/maneuvers:
1. Bulging flanks
2. Flank dullness
3. Shifting dullness
4. Fluid wave --> best test. + LR = 5.0
#evidencebasedmedicine #physicalexam
- Detected through 4 common physical exam signs/maneuvers:
1. Bulging flanks
2. Flank dullness
3. Shifting dullness
4. Fluid wave --> best test. + LR = 5.0
#evidencebasedmedicine #physicalexam
(4/8): Abdominal Varices:
One of the best physical exam findings. +LR = 9.5.
You can also determine the cause of varices by checking for the direction of flow at bedside. Check out this diagram and video by @ptfaddenMD (consent obtained per protocol)
One of the best physical exam findings. +LR = 9.5.
You can also determine the cause of varices by checking for the direction of flow at bedside. Check out this diagram and video by @ptfaddenMD (consent obtained per protocol)
(5/8) Portal HTN- flow is always AWAY from the umbilicus development of the portosystemic collaterals
SVC & IVC obstructions can also lead to abdominal vein distention!
IVC obstruction - flow will be cephalad (towards SVC) SVC obstruction - flow will be caudad (towards IVC)
SVC & IVC obstructions can also lead to abdominal vein distention!
IVC obstruction - flow will be cephalad (towards SVC) SVC obstruction - flow will be caudad (towards IVC)
(6/8) Asterixis:
Problem is inability to maintain a fixed posture
Assessed by patient holding both arms outstretched with fingers spread apart & looking for characteristic flap.
Other maneuvers:
- Elevate leg & dorsiflex the foot
- Close eyelids forcibly
- Portrude tongue
Problem is inability to maintain a fixed posture
Assessed by patient holding both arms outstretched with fingers spread apart & looking for characteristic flap.
Other maneuvers:
- Elevate leg & dorsiflex the foot
- Close eyelids forcibly
- Portrude tongue
(7/8) Historical fun fact:
In ancient Babylon, liver was considered the site of the soul
Priests predicted the future based on specific findings of the liver surface
They developed sheep liver clay models that were used to instruct those aspiring to the priesthood
#medhistory
In ancient Babylon, liver was considered the site of the soul
Priests predicted the future based on specific findings of the liver surface
They developed sheep liver clay models that were used to instruct those aspiring to the priesthood
#medhistory
(8/8) References:
- Lamb MG. The Rational Clinical Examination. JAMA. 1992;268(16):2165.
- McGee, S. (2021). Evidence-based physical diagnosis e-book. Elsevier Health Sciences.dd text
collection.sciencemuseumgroup.org.uk
- Society of bedside medicine
- Lamb MG. The Rational Clinical Examination. JAMA. 1992;268(16):2165.
- McGee, S. (2021). Evidence-based physical diagnosis e-book. Elsevier Health Sciences.dd text
collection.sciencemuseumgroup.org.uk
- Society of bedside medicine
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