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2014, Number 4

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Correo Científico Médico 2014; 18 (4)

Value of the physical examination in the diagnosis of ascites, hepatomegaly and jaundice in patients with liver cirrhosis

Rodríguez DM, Mulet PA, Miranda MZ, Pérez BAM, Pullés LM, Menéndez GE

Language: Spanish
References: 28
Page: 686-699
PDF size: 363.99 Kb.


ABSTRACT

Introduction: the physical examination is an important support in the diagnostic process focused on the liver.
Objectives: to determine the value of physical examination in the diagnosis of hepatomegaly, ascites and jaundice in admitted cirrhotic patients.
Methods: a retrospective descriptive study in a sample of 64 cirrhotic patients admitted from July 2010 to December 2011 to Vladimir Ilich Lenin hospital, Holguín, in which hepatomegaly signs and fluid wave were confronted against ultrasound as the reference test, jaundice and bilirubin front. Data were collected from individual medical records. Physical examination was performed on hospital wards, as reflected in the medical records. The Kappa concordance index and the operating characteristics of the signs were calculated.
Results: in the presence of low / no physical hepatomegaly ascites had good agreement with the ultrasound (Kappa: 0.79), sensitivity (100 %) and specificity (80 %), reducing the negative predictive value (27.3%) with ascites greater magnitude. The fluid wave reached good concordance (kappa: 0.63) and 81.3% accuracy. Kappa index reached an optimum value (Kappa: 0.97) for jaundice in the presence of hyperbilirubinemia ≥ 34.2 µmol/l, with 96.4 % sensitivity, 100 % specificity, and decreasing trend in the specificity and predictive positive value with increasing total serum bilirubin.
Conclusions: all physical signs were useful for diagnosis, with the exception of the hepatomegaly in presence of large amounts of ascites, being not advisable its categorical exclusion in that circumstance. Jaundice could efficiently be detected with values of hyperbilirubinemia ≥ 34.2 µmol/l.


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