Moffitt Intern Report: Acute Liver Failure and Cirrhosis Physical Exam Findings

Evidence based cirrhosis exam: Thanks to Brad for looking in his evidence-based exam textbook (a real, hard copy book!!) and finding us the likelihood ratio’s for cirrhosis on the following exam findings. If you want to read more, check out this paper from Brad as well.

  • Dilated abdominal wall veins, LR 9.5
  • Ascites, LR 6.6
  • Encephalopathy, LR 8.8
  • Spiders, LR 4.5
  • Gynecomastia, LR 7
  • Palmar erythema, LR 4.3


Acute Liver Failure: remember the following definition, but with 3 major exceptions that are not always taught (see below)

  1. INR >1.5
  2. Encephalopathy
  3. No evidence of chronic liver disease, unless they have one of the following 3 exceptions for chronic disease
    1. First presentation of HBV from vertical transmission
    2. Wilson’s disease
    3. Autoimmune hepatitis


To read more about the causes of acute liver failure and some of the multi-system effects that we discussed, please see this excellent review paper. Thanks for passing this along Leslie!


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