Signs of chronic liver disease

• Alopecia
• Foetor hepaticus: Sweetish, slightly faecal smell of breath similar to freshly opened corpse of mice, this is due to methyl mcrcaptan derived from methionine, occurring in hepatocellular failure
• Jaundicce
• Parotid swelling
• Gynaecomastia, testicular atrophy, loss of secondary sexual characters
• Spider naevi
• Palmar erythema- link Reddening of palms of the hands affecting the thenar and hypothenar eminences
• Dupuytren's contracture - This is a visible and palpable thickening of the palmar aponeurosis, most often of the ring finger, usually it is bilateral , occasionally affect the soles of the feet.
• Loss of hair - Axillary and pubic
• Muscle wasting
• Testicular atrophy
• Asterixis
• Xanthelasma.
• Look for signs of chronic cholestasis like scratch marks of pruritus and xanthelasma.

Stigmas of chronic compensated liver disease.

• Parotidomegaly
• Telangiectasia, spider naevi
• Gynaecomastia
• Palmar erythema 
• Clubbing
• Leukonychia 
• Dupuytren's contracture - This is a visible and palpable thickening of the palmar aponeurosis, most often of the ring finger, usually bilateral , occasionally affect the soles of the feet.
• Loss of hair - Axillary and pubic
• Muscle wasting
• Testicular atrophy

Stigmas of chronic decompensated liver disease. 
With the above features plus

• Altered sensorium
• Inversion of sleep rhythm 
• Jaundice
• Foetor hepaticus- Fetor hepaticus,sweetish, slightly faecal smell of breath similar to freshly opened corpse of mice due to methyl mercaptan derived from methionine, occurring in hepatocellular failure
• Flapping tremor - Ask the patient to stretch out his arms, separate the fingers and extend the wrist. Jerky irregular flexion extension movements at the wrist and metacarpophalangeal joints are noted. This tremor is absent when coma supervenes. Flapping tremor is also seen in respiratory, renal failure, occasionally in hypoglycemia and barbiturate intoxication
• Constructional apraxia
• Ascites, edema
• Hyperreflexia, extensor plantar.

Special stigmata of alcoholic cirrhosis 

• Bilateral enlarged parotids
• Gynaecomastia
• Testicular atrophy with loss of body hair
• Wasting of muscle mass
• Dupuytrens ’s contracture

What is hepatic facies?

• Hepatic facies is characterised by the following
• Shrunken eyes.
• Hollowed temporal fossa,
• Pinched-up nose with malar prominences
• Parched lips
• Muddy complexion of skin
• Shallow and dry face.
• Icteric tinge of conjunctiva.