From the Guidelines
A comprehensive physical examination for a patient with alcohol use disorder (AUD) should prioritize identifying both acute intoxication and chronic complications of alcohol use, focusing on vital signs, mental status, skin, neurological, cardiovascular, and abdominal examinations. When assessing a patient with AUD, it is essential to consider the severity of the disorder, which can be defined as mild (2-3 criteria), moderate (4-5 criteria), or severe (6 or more criteria), based on the DSM-V criteria outlined in the EASL clinical practice guidelines 1.
The examination should begin with vital signs, noting any hypertension, tachycardia, or fever, which may indicate withdrawal or infection. Assessing mental status for orientation, cognition, and mood disturbances is also crucial, as AUD can lead to significant psychological and cognitive impairments. The skin examination should focus on identifying signs of liver disease, such as spider angiomas, palmar erythema, jaundice, and bruising.
Key components of the physical examination also include:
- Checking for tremors, asterixis, and peripheral neuropathy by testing sensation, strength, and reflexes in all extremities
- Performing a thorough cardiovascular examination to listen for arrhythmias or signs of cardiomyopathy
- Conducting an abdominal examination to assess liver size, tenderness, ascites, and splenomegaly
- Assessing for nutritional deficiencies by examining for muscle wasting, glossitis, and peripheral edema
- Evaluating cerebellar function tests, such as finger-to-nose and heel-to-shin, to detect ataxia from cerebellar degeneration
- Testing eye movements for nystagmus and ophthalmoplegia to identify Wernicke's encephalopathy
These findings are essential in identifying complications that require immediate intervention, such as thiamine supplementation for Wernicke's encephalopathy, benzodiazepines for withdrawal, or referral for liver disease management, as outlined in the EASL clinical practice guidelines 1. The physical examination provides crucial information about the severity of alcohol-related organ damage and guides appropriate treatment planning.
From the Research
Key Components of a General Physical Examination
The key components of a general physical examination in a patient with alcohol use disorder (AUD) include:
- A complete history and physical examination 2, 3
- Laboratory tests, such as blood tests, to assess for alcohol-related medical disorders 2, 3, 4
- Evaluation of the patient's progress before, during, and after therapy, preferably with a validated instrument 2
- Assessment of the patient's quantity of daily alcohol intake 4
- Use of questionnaires, such as CAGE or AUDIT, to assess for alcoholism 4
- Measurement of specific laboratory markers, such as CDT, GGT, or MCV, to assess for alcohol-related disorders 4
Importance of Physical Examination
A physical examination is crucial in diagnosing and managing AUD, as it can help identify:
- Autonomic hyperactivity, tremor, nausea or vomiting, hallucinations, psychomotor agitation, anxiety, and grand mal seizures, which are symptoms of alcohol withdrawal 2, 5
- Coexisting addictions and common medical, surgical, and psychiatric comorbidities 6
- Alcohol-related medical disorders, such as liver disease or cardiovascular disease 3, 4
Laboratory Tests and Markers
Laboratory tests and markers can help assess the severity of AUD and monitor the patient's progress, including: