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Merck Manual...

Dear Doctor,

Here is a page from the Merck Manual:

http://www.merckmanuals.com/professional/hepatic_and_biliary_disorders/fibrosis_and_cirrhosis/cirrhosis.html

Immediately below is an excerpted statement that I frankly found surprising.  Any comments or feedback welcome - thank you!!

PD


Quoting the Merck Manual:  
"Clinical signs that suggest a chronic liver disorder or chronic alcohol use but ARE NOT SPECIFIC FOR CIRRHOSIS** include muscle wasting, palmar erythema, parotid gland enlargement, white nails, clubbing, Dupuytren's contracture, spider angiomas (< 10 may be normal), gynecomastia, axillary hair loss, testicular atrophy, and peripheral neuropathy."

** emphasis added.  This statement seems to suggest that one could be presenting with any or all of these symptoms - and yet still not be cirrhotic.  Presumably it's saying that F3 status...a seriously damaged/fibrotic liver that's not yet cirrhotic...could present with any or all of these symptoms.  

My question is twofold:

(a) Is the above an accurate statement?  Do you have a differing interpretation... and/or remarks?

(b) What is the likelihood of frank cirrhosis in a mildly anemic patient with all normal LTFs and a platelet count of 271,000?  Does such a 'fully normal' platelet count necessarily preclude frank cirrhosis?

Many thanks!
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Thomas D Schiano, MDBlank
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