Physical Signs in the Diagnosis of Cirrhosis

Physical signs appear not to be useful for excluding cirrhosis because of their low sensitivity, but they may be useful to confirm cirrhosis in those with moderate to high pre-test probability of disease. Level of evidence: "B"

A systematic review 1 including 12 studies with a total of 1,895 subjects was abstracted in DARE. Physical signs such as ascites, jaundice, collateral circulation, spider angiomata, palmar erythema) generally had low sensitivity for the diagnosis of cirrhosis and, therefore, were not useful for excluding disease. Signs with higher specificity (such as ascites, encephalopathy, jaundice), which may be useful to confirm cirrhosis in those with moderate to high pre-test probability of disease, tended to be associated with clinically decompensated disease.

Comment: The quality of evidence is downgraded by indirectness (inclusion of highly selected patients).

References

de Bruyn G, Graviss EA. A systematic review of the diagnostic accuracy of physical examination for the detection of cirrhosis. BMC Med Inform Decis Mak 2001;1:6. [PubMed] [DARE]

Primary/Secondary Keywords

evidence summary
DARE
systematic review
Cirrhosis
Diagnosis

Palmar erythema

Spider angioma

Jaundice

Ascites

Signs
Signs and symptoms

section name header

Evidence summaries

Physical Signs in the Diagnosis of Cirrhosis

References