What is a characteristic physical exam finding for liver failure?

Scleral icterus, the yellowing of the whites of the eyes, is a classic physical exam finding associated with liver failure. This occurs due to the accumulation of bilirubin in the bloodstream, which happens when the liver is unable to process and eliminate it effectively. In liver failure, the liver's capacity to conjugate bilirubin is diminished, leading to its deposition in tissues including the sclera. This discoloration is one of the most recognizable signs of liver dysfunction and is often one of the first manifestations noted in a patient with liver failure.

Other findings, while significant in various contexts, do not specifically indicate liver failure. Rales are typically associated with pulmonary conditions and reflect fluid in the lungs. A swollen abdomen may indicate a range of issues, such as ascites or other causes of abdominal distension, but is not uniquely specific to liver failure. Decreased breath sounds can occur in numerous respiratory conditions and are not indicative of liver function. Thus, scleral icterus stands out as a characteristic and direct indicator of liver failure.