Bad liver can be understood as people with liver diseases, and the scope of liver diseases is very wide, including viral hepatitis, alcoholic liver disease, fatty liver, liver cirrhosis, liver cancer, and some benign liver diseases that do not need treatment, such as asymptomatic liver cysts and hepatic hemangioma, etc.
some of these liver diseases will show up in their hands, while others will not. If there are some signals on the hand, we should be alert to the occurrence of liver disease, but do not think that these signals must represent liver disease.
the blood circulation of palm, especially thenar, thenar and finger pulp, is very rich. When we stretch our fingers in natural light, we can clearly see where there is redness.
but when the hand is in normal activity, or when the palm is suddenly released after being squeezed, the palm will be congested, showing that the palm is red, which is a physiological phenomenon.
liver palm refers to the skin redness of the palm, which is a kind of flush appearance, especially the thenar of the thumb and little finger. It is common in patients with chronic liver disease, normal pregnant women, hyperthyroidism, rheumatoid arthritis and polycythemia.
the specific cause of liver palms is still not completely clear. Most people think that it is because the liver function metabolism of patients is damaged, and the inactivation ability of estrogen is decreased, which leads to a large amount of accumulation or accumulation of estrogen in the body, resulting in local telangiectasia.
when there is jaundice, the palm or palm is not the first yellow part, the first yellow part is the sclera of the eyes, so if the hands are yellow, it means that jaundice is obvious.
jaundice indicates the increase of bilirubin. When hepatitis attacks or bile duct lesions, if jaundice aggravates, it often indicates the aggravation of the disease, we should pay special attention to it. Of course, also want to distinguish is false jaundice.
pestle fingers are characterized by the obvious widening and thickening of the knuckles at the end of the fingers, and the arched protrusion of the fingernails from the root to the end, so that the basal angle formed by the skin on the back of the fingertips and the fingernails is equal to or greater than 180 degrees.
when the normal nail protrudes from the fingertip, it usually presents an obtuse angle of 160 degrees, especially the thumb. If you don’t understand, just straighten your thumb and have a look. After clubbing, the obtuse angle is not seen, but the opposite angle is shown, and the volume of the finger bone at the end increases.
the pathogenesis of clubbing finger is still unclear. It is generally believed that it is caused by the expansion and proliferation of blood vessels at the fingertip in order to obtain more oxygen when the arterial oxygen content is insufficient due to pulmonary arteriovenous shunt. Common in chronic respiratory infection, lung cancer and other lung diseases, cirrhosis can also appear clubbing fingers.
manicure is caused by the whiteness of the nail, which makes the nail opaque. It is often located at the far end and edge of the nail bed. It can be seen in patients with hypoalbuminemia caused by chronic liver disease, nephrotic syndrome and protein loss enteropathy, which is related to the blocked capillary circulation caused by the accumulation of extracellular fluid.
metacarpal fascia contracture is a progressive disease, which is caused by the thickening of metacarpal fascia and extending to the finger fascia, eventually leading to the contracture of metacarpophalangeal and interphalangeal joints. It is more common in the ring finger. The incidence rate of
is relatively high in Europe and America. Some sporadic cases can also be seen in China. Generally, the development is slow and there is no discomfort in the early stage. But palpation can be found to increase the thickness of the palm skin of the patient.
palmar fascia contracture is mostly bilateral involvement, occasionally involving the sole of the foot. This phenomenon is found in liver diseases, which is more common in alcoholic liver disease caused by alcoholism, especially in alcoholic cirrhosis.
flapping wing tremor refers to that during the examination, the patient should close his eyes, raise his hands flat, separate his five fingers, fully extend his arm and wrist, and the arm is parallel to the ground. The patient’s wrist and metacarpophalangeal joint should be observed by others to see if there will be rapid and irregular paroxysmal bird wing flutter like flexion and extension movement, which is one of the manifestations of hepatic encephalopathy.
the occurrence of this situation indicates that the metabolic disorder in the patient’s body impairs the transmission of joint position information to the brain stem, resulting in involuntary flexion and extension. It is a characteristic manifestation of acute and chronic liver failure, but it can also be seen in patients with heart failure, respiratory failure and renal failure.
the diagnostic criteria of trichia are as follows: fingertip pink brown narrow band, width of 0.5-3.0 mm; venous return of nail bed is reduced without passing through fingertip; proximal nail is white or light pink; half moon mark of nail may disappear; at least 4 of 10 nails meet the above criteria.
studies have shown that trichia is significantly associated with liver cirrhosis, chronic heart failure and type 2 diabetes, especially for young patients. Of course, Terry’s nails can also be seen in hyperthyroidism, malnutrition, pulmonary eosinophilia, actinic keratosis and some elderly patients.
patients with chronic liver disease should carefully check their hands and nails, because there are many changes that can be reflected in their hands. So it’s worth the time. However, these signs are not specific and further examination is needed if liver problems are suspected.
these further tests include: blood routine, liver function, renal function, prothrombin time, international standardized ratio, blood ammonia, alpha fetoprotein, B ultrasound, CT, MRI, liver hardness test, etc.
I am a clinician who loves popular science. I can see a doctor, consult, answer questions, solve puzzles, popularize medical knowledge, and experience the power of warm words in the rush of clinical work! 08/17/2020