3. Substance Use Disorder

Physical Examination

Excess alcohol consumption leads to certain physical signs

They are divided into

  • Vitals
  • Head and Neck
  • Skin
  • Abdomen
  • Genitourinary
  • Extremities


  • Fever may be present

Head and Neck

  • Fetor hepaticus (breath smelling like a freshly opened corpse)
  • Parotid hypertrophy
  • Poor dentition
  • Scleral icterus (yellowish pigmentation of sclera)


  • Jaundice
  • Abnormal dark or light patches of skin
  • Spider angiomata
  • Gynecomastia
  • Bruising or other indications of thrombocytopenia
  • Striae


  • Hepatosplenomegaly
  • Abdominal distention
  • Palpable liver edge
  • Abdominal tenderness
  • Ascites
  • Fluid wave (due to ascites)
  • Right upper quadrant tenderness


  • Testicular atrophy


  • Muscle atrophy
  • Asterixis (abrupt/intermittent loss of )
  • Palmar erythema


  • Confusion, coma (hepatoencephalopathy) may be present
  • Evidence of Wernicke’s or Korsakoff’s syndrome - occurs due to lack of vitamin B1 - caused by alcohol

[[Pasted image 20210705110335.png]]

  • Patient has shown these symptoms :

Patient also gives history of sleeplessness with seeing insects crawling,screaming sounds and noises, at times gets startled and wakes up from bad dream

[[Pasted image 20210705110838.png]]