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Examination of the abdominal system

General inspection • General inspection of the hands: look at the nails for

signs of leukonychia which may indicate low albumin in liver disease, koilonychia which may indicate iron deficiency, clubbing which may indicate inflammatory bowel disease, cirrhosis and coeliac disease in the abdominal system

• Note the palms – palmar erythema, a blotchy redness of the palms, may indicate chronic liver disease in the abdomen

• Examination for liver flap – this is similar to the flapping tremor of carbon dioxide retention (see Respiratory chapter). It is characteristic of encephalopathy if present.