A 45-year-old man has a long history of chronic alcoholism and comes to the physician because of increasing malaise for the past year. He was hospitalized 1 year ago because of upper gastrointestinal hemorrhage. Physical examination shows a firm nodular liver. Laboratory findings show a serum albumin level of 2.5 g/dL and prothrombin time of 28 seconds. Which of the following additional physical examination findings is most likely to be present?
Diminished deep tendon reflexes
Answer:C Caput medusae
This patient has alcoholic cirrhosis with portal hypertension. Venous collateral flow can be increased in esophageal submucosal veins, producing varices, and in the abdominal wall, producing caput medusae.
The coagulopathy from decreased liver function may lead to purpuric hemorrhages, but splinter hemorrhages of the nails are most characteristic of embolization from infective endocarditis.
Liver failure with cirrhosis may lead to hepatic coma, but brain swelling with papilledema is not a major feature.
Hyperreflexia, but not diminution of deep tendon reflexes, can occur when hepatic encephalopathy develops.