Which of the following is a clinical skin manifestation of liver cirrhosis?

Appeared in: NHM UP Staff Nurse - 2019

Explanation

Palmar erythema is a classic cutaneous sign of chronic liver disease, including cirrhosis.
It presents as redness on the palms, particularly over the thenar (base of thumb) and hypothenar (base of little finger) eminences, as shown in the image.
The underlying cause is hyperestrogenism due to the liver's decreased ability to metabolize estrogen, which leads to peripheral vasodilation and increased blood flow to the skin of the palms.

Option B: Diffuse erythema of the face is not a specific or characteristic sign of liver cirrhosis.
Option C: General erythema of the neck is not a recognized sign of liver cirrhosis.
Option D: Shoulder erythema is not associated with liver cirrhosis.

Clinical Relevance

Nursing practice connection: Knowing Cutaneous manifestations of liver cirrhosis helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A nurse's ability to recognize skin signs like palmar erythema during a physical assessment can prompt further investigation for underlying, potentially undiagnosed, chronic liver disease.
These signs are part of the larger clinical picture of liver decompensation, and their presence should lead to monitoring for ascites, variceal bleeding, and hepatic encephalopathy.
What if the patient also has small, red, spider-like lesions on their upper chest? This finding, suggestive of spider angiomas, would further strengthen the suspicion of liver cirrhosis, as both palmar erythema and spider angiomas share the same pathophysiological basis (hyperestrogenism).

How to Approach the Question

First, identify the core concepts in the question: 'skin manifestation' and 'liver cirrhosis'.
Carefully examine the provided image. Observe the specific location and appearance of the skin change. Note the redness is on the palms of the hands.
Correlate your visual analysis with the given options. The image clearly depicts what is described as 'Palmar erythema'.
Recall or use your knowledge of the clinical signs of liver cirrhosis. Palmar erythema is a well-known sign.
Evaluate the other options. Erythema on the face, neck, or shoulders are not specific or classic signs of cirrhosis, making them incorrect distractors.
Select the option that accurately names the condition shown in the image and is a known manifestation of liver cirrhosis.

Concept Tested & Keywords

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E6 Medicine Harrison 22e Part 2 pp. 613-615, 533-535

E6 Medicine Davidson Principles Practice 24e p. 866-868

Practise the full NHM UP Staff Nurse - 2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.