Physical exams, seemingly forgotten, can help diagnose cirrhosis

SAN ANTONIO – Despite the best medical training in the world, new trainees in hepatology often lack the primary training in giving a full physical exam, according to an expert at the National Liver Conference 2019.

“The physical exam is forgotten. My Harvard trainees, UCSF trainees, Michigan trainees came to Ship Rock and ... it’s amazing what they don’t know,” Bruce A. Runyon, MD, FAASLD, special hepatology consultant to the Indian Health Services, said during his presentation. “They just copy and paste a three-page physical exam that they didn’t do at all. No way; you have to do it.”

Runyon said these physicians often fall prey to LGFD – looks good from doorway – and often conduct a quick exam with street clothes still on the patient.

“New patients you put in an exam gown,” Runyon said. This allows for better listening for features like Cruveilhier-Baumgarten hum or bruit, which is present in up to 59% of severe alcoholic hepatitis. It also gives the opportunity to look for spiders, palms, collaterals and palpate sub-xiphoid for left lobe.

“We own the patient. ... We really have to function as their primary care physician,” he said, especially when they compensate. – by Katrina Altersitz

Reference: Runyon BA. Continuum of Care of the Patient with Cirrhosis. Presented at: National Liver Conference; Oct. 25; San Antonio.

Disclosures: Runyon reports no relevant financial disclosures.