General examination – 
Patient is not in pain, breathless, 
 
hands – for clubbing – 
pulmar erythema
deputrance contraction – 
flapping tremor 
 
pulse – rate , rhythem vol caracter 
Spider nevia – 
Eye – icterus , palor – Cu ring 
parotid glands – enlarged 
Glottis , angular stomatitis 
breath – alcohol 
gynacomastia Spider nevia – 
testiculer atrophy 
 
ankle swellings – 
 
Inspection – 
Swelling ( distention) , scar, skin chanegs – caput 
hernial orificus – for hernia ( ask him to cough )  – inguinal – femoral and umbilical 
 
( then we do the auscultation ) 
 
Superfitial palpations
Deep Palpation – 
Liver examiantion – purcuss as well  
spleen examiantion – 
Kidney examiantion 
 
Ascitic –  – if no gross ascitis
 purcuss 
 ( horse shoe dullness, shifting dullness )
 
then exaine the genitelia – scrotem – 
and then the anal examination – 
 
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