You should examine for encephalopathy and jaundice. Right upper quadrant pain may be present.

Signs of chronic liver disease would suggest either acute on chronic liver failure or decompensated liver disease.

Signs of chronic liver disease include:

  • Clubbing
  • Leukonychia
  • Palmar erythema
  • Asterixis
  • Spider naevi
  • Scratch marks
  • Loss of secondary sexual characteristics
  • Hepato/splenomeglay
  • Ascites
  • Oedema
  • Kayser-Fleisher rings (Wilson disease)
  • Features of preeclampsia (HELLP syndrome)