A liver biopsy is the only definitive test that actually indicates whether or not you have cirrhosis [irreversible scaring of the liver]. So, what exactly is your doctor looking for when he/she does a physical exam? Are there actually some physical clues that suggest that you have cirrhosis? The answer to this question is yes.

The following is a list of 19 clues that indicate that you may already have cirrhosis. These are listed alphabetically by their common medical name. It is important to remember that, although helpful, each of these physical manifestations do not indicate the actual cause of one's liver disease, and, in fact, are not specific only to liver disease. They can be due to other disorders as well.

• ASCITES: An accumulation of excess fluid in the abdomen. Causes abdominal distention. Can be treated with a low sodium diet, and the use of diuretics, i.e. water pills.
• ASTERIXIS: An uncontrollable flapping of the hands that becomes noticeable when patients stretch out their arms, palms out, as if stopping traffic. Is associated with mental confusion, i.e. encephalopathy.
• CAPUT MEDUSA: Enlarged blood vessels that snake out from the belly button in a patient with ascites.
• DUPUYTREN'S CONTRACTURE: A puckering of the palms that prevents people from totally straightening out their hand. Usually associated with alcoholic liver disease.
• EDEMA: Fluid accumulation in the legs, especially the ankles. Usually associated with ascites.
• ENCEPHALOPATHY: An altered mental status leading to coma. Can be treated with animal protein restriction and a poorly absorbed sugar called Lactulose.
• FETOR HEPATITICUS: A particularly foul "dead mouse" smell found on the breath. Frequently precedes coma.
• GYNECOMASTIA: Enlarged, tender breasts in men. Commonly associated with alcoholic cirrhosis, but may also be due to Aldactone, a drug used to control ascites.
• HAIR LOSS: Hair becomes sparce in men from the face, chest and pubis, and under the arms in women.
• JAUNDICE: A yellow discoloration of the skin due to an elevated bilirubin level.
• MUSCLE WASTING: Loss of muscle mass, seen in end-stage cirrhosis when the liver can no longer manufacture proteins.
• PALMAR ERYTHEMA: Bright red coloring of the palms, particularly at the base of the thumb and little finger. May be due to excess estrogen.
• PAPER MONEY SKIN: Numerous small blood vessels that resemble the silk threads in a U.S. dollar bill. Commonly cover the upper body.
• PAROTID GLAND ENLARGEMENT: Enlargement of a gland on the face located under the ear. Causes an unusual appearance of the protrusion of the earlobes straight out from the jaw.
• SCLERAL ICTERUS: Yellow discoloration of the whites of the eyes [sclera], due to an elevated bilirubin level.
• SPIDER ANGIOMATA: Enlarged blood vessels that resemble little spiders. Usually found on the upper chest,back, face, and arms. Turn white when their center is touched [blanches]. More common in alcoholic cirrhosis.
• SUBACUTE BACTERIAL PERITONITIS: Fever, and abdominal pain in a patient with ascites.
• TERRY'S NAILS: The normal pinkish color of the nails turns completely white, with the disappearance of the half-moon circles at the base of the nails.
• UMBILICAL HERNIA: Protrusion of the belly button [umbilicus], in a patient with massive ascites.

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