List nonspecific features.
Patients are often initially asymptomatic.
Fatigue, malaise, anorexia, and weight loss
List dermal features.
Pruritus
Jaundice
Telangiectasia: most commonly spider angiomata
Caput medusae: paraumbilical dilation of subcutaneous veins
Palmar erythema (plantar erythema also possible) [7]
Petechiae and purpura
Generally dry and atrophic
White nails with ground-glass opacity (also known as “Terry nails”)
Nail clubbing
Lacquered lips, smooth red tongue
List abdominal features.
Nausea, vomiting
Hepatomegaly (possibly causing dull RUQ pain)
Splenomegaly
Ascites
List hormonal disorders.
Hyperestrogenism
Changes in the hepatic metabolization of sex hormones cause an imbalance in the estrogen-androgen ratio, resulting in a marked increase in systemic estrogen levels.
In men, increased estrogen levels cause feminization.
Gynecomastia
Hypogonadism (e.g., testicular atrophy, reduced libido, erectile dysfunction, infertility)
Decreased body hair (e.g., loss of chest hair, a female pattern of pubic hair distribution)
In women, a massive increase in estrogen can cause amenorrhea.
List other clinical features.
Asterixis
Fetor hepaticus: bad breath with a characteristic sweet, pungent smell caused by an accumulation of dimethyl sulfide
Dupuytren contracture
Peripheral edema
List specific clinical features due to rare etiologies.
Hemochromatosis: dark, bronze skin color, and diabetes (bronze diabetes)
Wilson disease
Neurological/psychiatric symptoms (parkinsonism and personality changes)
Indirect hyperbilirubinemia due to hemolysis.
Alpha‑1 antitrypsin deficiency: lung emphysema before 50 years of age [
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