What are the abdominal findings in a patient with liver cirrhosis?

From the Guidelines

In a patient with liver cirrhosis, the abdominal examination typically reveals several characteristic findings, including a distended abdomen due to ascites, which is the accumulation of fluid in the peritoneal cavity resulting from portal hypertension and decreased albumin production by the damaged liver, as described in the guidelines on the management of ascites in cirrhosis 1. The abdomen may appear distended due to ascites, and on palpation, the liver might feel firm, nodular, and have a blunted edge if it's enlarged, though in advanced cirrhosis it may actually be small and shrunken. Some key findings in the abdominal examination of a patient with liver cirrhosis include:

• Ascites, which is the most common complication of cirrhosis, as noted in the guidelines on the management of ascites in cirrhosis 1
• Splenomegaly, which is often present due to portal hypertension
• Prominent superficial veins, known as caput medusae, which represent collateral circulation developing as blood attempts to bypass the obstructed portal system
• Umbilical hernias from increased intra-abdominal pressure, as mentioned in the practice guidance by the American Association for the Study of Liver Diseases 1
• A palpable gallbladder if there's biliary obstruction, and tenderness in the right upper quadrant if there's acute inflammation These physical findings, combined with other signs of liver disease such as jaundice, spider angiomas, palmar erythema, and asterixis, help establish the diagnosis and assess the severity of cirrhosis. The occurrence of ascites impairs patient working and social life, often leads to hospitalisation, requires chronic treatment and is a direct cause of further complications, such as spontaneous bacterial peritonitis, restrictive ventilatory dysfunction, or abdominal hernias, as discussed in the EASL clinical practice guidelines for the management of patients with decompensated cirrhosis 1. The presence of ascites is a significant finding in the abdominal examination of a patient with liver cirrhosis, and its management is crucial to improve the patient's quality of life and reduce the risk of complications, as emphasized in the guidelines on the management of ascites in cirrhosis 1.

From the Research

Abdominal Description in Liver Cirrhosis

The abdomen of a patient with liver cirrhosis may exhibit several characteristics, including:

• Ascites, which is the accumulation of fluid in the peritoneal cavity, and is the most common complication of cirrhosis 2
• Distended abdomen due to the accumulation of ascitic fluid
• Possible presence of esophageal varices, which are enlarged veins in the esophagus that can bleed easily 3
• Signs of portal hypertension, such as splenomegaly (enlarged spleen) and abdominal venous distension

Complications of Liver Cirrhosis

The complications of liver cirrhosis can further affect the abdominal description, including:

• Spontaneous bacterial peritonitis, which is an infection of the ascitic fluid 2
• Hepatorenal syndrome, which is a type of kidney failure that can occur in patients with cirrhosis 2
• Recurrent or refractory ascites, which can lead to further complications such as abdominal discomfort and respiratory distress 2
• Hepatic hydrothorax, which is the accumulation of fluid in the pleural cavity 2

Management of Liver Cirrhosis

The management of liver cirrhosis can also impact the abdominal description, including:

• Diuretics and sodium restriction to manage ascites 2
• Paracenteses, which is the removal of ascitic fluid through a needle 2
• Non-selective beta-blockers to prevent ascites and variceal bleeding 3
• Transjugular intrahepatic portosystemic shunt (TIPS) to reduce portal pressure and prevent variceal bleeding 3