- Obtain patient consent for the examination
- Note the patient’s colour: jaundice or pigmentation
- Look at their body habitus: cachectic and loose skin, or skin tethering, or overweight
- Consider briefly their mental state: cloudy, confused, disorientated
Hands
- Nails: clubbing, leukonychia, (and koilonychia)
- Palms: palmar erythema, Dupuytren’s contracture, pallor
- Hepatic flap (asterixis)
Arms
- bruising, muscle wasting
- scratch marks –> axillary nodes
- spider naevi (+/- telangiectasiae)
Face
- Eyes: jaundice, conjunctival pallor (anemia)
- Keiser-Fleischer rings (copper deposition), iritis (autoimmune disease), xanthelasma (lipids)
- Parotids
- Mouth:
- teeth (and breath) and gums (hypertrophy, pigmentation)
- tongue and leucoplakia (glossitis)
- ulcers
- thrush
- Neck / chest:
- cervical nodes
- spiders / gynaecomastia (axillary and pubic hair, testis etc.)
Abdomen – lie flat, expose from inguinal area to just below nipple
- Inspection
- scars + skin lesions (striae, Herpes zoster, metastatic nodules)
- distension + localised swellings and herniae
- prominent veins
- pulsation or visible peristalsis
- Palpation
- guarding and rigidity (or rebound)
- any masses> – describe
- liver tenderness or pulsatile etc., spleen, kidneys (ballotable)
- Percussion
- liver span +/- spleen / kidneys
- ascites
- Auscultation
- bowel sounds
- friction rub, venous hum, bruits
Hernial orifices
Inguinal Nodes
Testes
Per rectal (PR) examination +/- proctosigmoidoscopy
Other
- legs: bruising, swelling, peripheral neuropathy, pulses
- urinalysis
- temperature
- stools / vomitus
