Physical Examination in Case of Alcohol Use Disorder
The examination begins with an inspection of the general demeanour and physique.
General Physical Examination
On general physical examination, observe signs of agitation, sweating, and bruises and note the respiratory rate.
- Agitation or restlessness
- Respiratory rate
Examination of hands and arms
Examine the arms and hands for signs of hepatic disease or cerebellar dysfunction (tremor/dysdiadokokinesia and finger-nose test).Inspect for
- Palmar erythema
- Dupuytren’s contracture
- Nicotine stains
- Then examine tremor and dysdiadokokinesia (by asking the patient to tap the palm of one hand with the fingers of the other, then rapidly turn over the fingers and tap the palm with the back of them, repeatedly).
- Perform finger-nose test
- For hepatic flap-ask the patient to hold arms straight with hyper-extended hands. Look for an intermittent loss of tone in the wrists, with the appearance of a flap.
- Check pulse rate and blood pressure
Examination of eyes
Check extraocular muscles and rule out nystagmus
MouthExamine the patient's mouth for any signs of oral thrush, which can indicate impaired immune function, as well as any evidence of alcoholic stomatitis, which is a condition characterized by painful ulcers in the mouth.
- Spider naevi
- Loss of body hair
- Auscultate for heart sounds
Palpate the patient's abdomen to assess for any tenderness or masses, which may indicate liver disease or pancreatitis.
- Scratch marks
- Caput medusae
- Umbilicus everted/inverted
- Palpate liver and spleen
- Check for ascites
- Ask to check the external genitalia for testicular atrophy
Perform a neurological examination to assess for any signs of peripheral neuropathy, such as muscle weakness, impaired coordination, and loss of sensation in the extremities.
- Check reflexes
- Check for peripheral neuropathy and proximal myopathy
- Perform heel-shin
- Assess gait