Stigmata of Chronic Alcohol Excess & Chronic Liver Disease

Visual / at-a-glance recognition reference — prehospital, no bloods required

None of these confirm haematological or synthetic liver derangement on their own. They raise index of suspicion for occult coagulopathy, thrombocytopenia, and varices — enough to treat a "minor" bleed or head injury with more caution than it looks.

Facial telangiectasia

Fine dilated capillaries, cheeks/nose, sometimes persistent flush. Direct vasodilatory effect of alcohol.
Parotid gland hypertrophy underrated

Bilateral parotid swelling squares off / puffs the lower face and jawline — often what registers as "off" without an obvious cause.
Rhinophyma-type nasal change

Bulbous, textured nose. More rosacea-linked but clusters overlap heavily.
Scleral/conjunctival changes

Injection early; yellow-grey jaundice tinge in more advanced disease (reduced bilirubin clearance).
Sallow / grey skin tone

Poor pigment clearance plus nutritional depletion.

Thin, dull, prematurely grey hair

Nutritional deficiency — protein, zinc, B vitamins.
Spider naevi

Central arteriole with radiating capillaries, blanch on pressure. Chest/shoulders/face. Driven by hyperoestrogenism (impaired hepatic oestrogen breakdown).
Palmar erythema

Redness of thenar/hypothenar eminences — same oestrogen mechanism.
Thin, easily bruised skin

Hints at coagulopathy/thrombocytopenia — nonspecific alone but adds to picture.

Central adiposity + peripheral wasting key silhouette cue

Fat/fluid accumulates centrally (abdomen — ascites or visceral fat) while limbs look disproportionately thin. This is the main driver of the "small arms/legs vs torso" read.
Muscle wasting

Temporalis, shoulder girdle, quads — poor nutrition, reduced hepatic protein synthesis, reduced activity.
Gynaecomastia (men)

Oestrogen effect, subtly changes chest shape.
Ascites

Tense, shiny, fluid-filled abdominal distension — distinct from simple obesity. Sometimes everted umbilicus.
Caput medusae portal HTN

Dilated paraumbilical veins radiating from the umbilicus — portal hypertension decompressing via the ligamentum teres remnant.
Splenomegaly

Palpable if you're examining — portal hypertension, contributes to thrombocytopenia via sequestration.

Asterixis (liver flap)

Coarse flapping tremor on wrist extension — suggests hepatic encephalopathy, more advanced disease.
Dupuytren's contracture

Palmar fascia thickening/contracture, classically ring/little finger. Associated but not specific.