The record
The patient is icteric, pigmented. He has clubbing, leuconychia, palmar erythema and dupuytren's contracture and several spider naevi.There is or there is no flapping tremor of the hands. There is scratch marks on the forearms and back, and there is purpura. There is gynaecomastia, scanty hair and his testes are small.
also he has generalized swelling of the abdomen and the umblicus is everted there is distended abdominal wall veins in which the flow is away from, the umbilicus.The liver is palpable at .. cm below the right costal margin with a span of about cm indicating hepatmegaly and 3 cm splenomegaly. The flanks are dull to percussion but the center is resonant. The dullness is shifting and fluid thrill is present or not present so he has ascites. ankle edema is also present .
The diagnosis is likely to be cirrhosis of the liver with portal hypertension.
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