Jaundice

Refeeding

PPI S/E : AIN > AKI, osteoporosis, K/Mg imbalance

Signs of chronic liver disease :

Ascites : hypoalbuminemia + portal hypertension

U/S & CT detects from at least 100 ml of ascitic fluid

Puddle sign (Sn 50% / Sp 50-80%) detects from at least 120 ml of ascitic fluid

Shifting dullness detects from 500 ml

Fluid thrill detects 1000-1500 ml

Cirrhosis

Caput medusae : portal hypertension → varices—hemorrhoids—splenomegaly

differentiate cause by blood flow direction

subumbilical veins draining outwards = portal hypertension

subumbilical veins draining inwards = portal vein thrombosis

subumbilical veins draining upwards = obstructive IVC

Gynecomastia : impaired estrogen breakdown

Icterus : dysfunctional metabolism of bilirubin

Palmar erythema : impaired estrogen breakdown

Spider nevi : impaired estrogen breakdown → dilatation of small arteries → telangiectasia

Ecchymosis : dysfunctional coagulation

Leukonychia : hypoalbuminemia

Terry‘s nail = white nail = low blood flow

Finger clubbing

Asterixis

Fector hepaticus : excess aromatic compounds