Clinical Signs and Symptoms — Examination Findings

A 52-year-old man with a 15-year history of alcohol use disorder presents to the outpatient clinic with progressive abdominal distension and ankle swelling over the past 3 months. On examination, he has a firm, enlarged liver edge palpable 4 cm below the costal margin, splenomegaly, and shifting dullness on percussion of the abdomen. His jugular venous pressure is not elevated. Laboratory tests show albumin 2.8 g/dL, total bilirubin 3.2 mg/dL, and INR 1.8. What is the most likely clinical sign that would be expected on further examination of his abdomen?

A 48-year-old woman with a 10-year history of primary biliary cholangitis (PBC) presents with progressive fatigue and pruritus. On examination, she has xanthomas on the dorsal surfaces of her hands and eyelids, and her skin shows a brownish discoloration. Her liver is palpable 3 cm below the costal margin and feels firm. Serum alkaline phosphatase is 320 U/L, gamma-glutamyl transferase is 280 U/L, and total bilirubin is 4.1 mg/dL. What is the most likely explanation for the brownish skin discoloration observed in this patient?

A 48-year-old woman with a 10-year history of alcohol use disorder presents with complaints of abdominal pain and bloating for 3 months. On physical examination, you note the following: prominent abdominal wall veins running from the umbilicus toward the flanks, a palpable nodular liver edge, and dullness to percussion in the flanks that shifts with position change. Her abdomen is soft and non-tender. What is the most specific clinical sign present on examination that indicates chronic liver disease with portal hypertension?

Which clinical sign is characterized by a pulsatile hepatomegaly with a systolic impulse felt below the costal margin?

What is the term for the characteristic abdominal wall vein pattern seen in portal hypertension radiating outward from the umbilicus?