Mansoor Nadeem, Muhammad Ali Yousaf, Manzar Zakaria, Tasawar Hussain, Nadir Ali.
The value of clinical signs in diagnosis of cirrhosis.
Pak J Med Sci Jan ;21(2):121-4.

Objective: To document the value of various clinical signs of cirrhosis in its diagnosis. It also reviews the current status of the disease. Design: Observational and descriptive study. Place and duration of study: Medical wards of PNS Shifa, Karachi and Jinnah Postgraduate Medical Center, Karachi, Pakistan from June 2002 to May 2003. Subjects and Methods: One hundred and seventy diagnosed adult patients having an unequivocal evidence of cirrhosis on ultrasound examination of abdomen were included in the study. Two trained clinicians examined the cases and their clinical signs were recorded on a format specially designed to record the clinical signs. Age, gender, hepatitis status (hepatitis B, C, or other wise) was also documented. Results: Sixty two percent were males and 38% were females. Patient average age was 53.2 years without gross age difference in the HCV positive and HBsAg positive groups. Twenty eight percent were HCV positive, 22% were HBsAg positive, 10% had no evidence of previous infection of hepatitis B or hepatitis C and 40% had no record of these tests. Males dominated the HBsAg group compared to HCV positive group. Pedal edema was present in 92 percent of patients, ascites in 89 percent, jaundice in 64 percent, clubbing in 25 percent, palmar erythema in 23 percent, Terry`s nails in 21 percent, testicular atrophy in 4 percent, gynaecomastia in 4 percent, pectoral area hair loss in 2.4 percent, leuconychia in 2.4 percent and hepatic encephalopathy in different grades in 19 percent. No spider navei, caput medusae and Dupuytren`s contracture were noted. Conclusion: We document that in current clinical practice the classical signs of cirrhosis expected to be present in advanced cases are observed quite infrequently and therefore, cannot be relied upon in clinical diagnosis of the disease alone. The diagnosis of cirrhosis should be supported by other means including ultrasound examination of the abdomen etc. Further multicenter studies should be conducted to consolidate our findings.

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