The introduction here may be “examine the abdomen” or “this man has recently become diabetic” or “this man has noticed a change in his appearance”. Obviously if the introduction is “this man has difficulty with his hands” then examine them formally first.
Start by examining the hands for signs of CLD including flap. Then note any arthropathy, in particular over the 2nd and 3rd metacarpals. Feel for synovitis over these joints and note their range of movement, also ask the patient to form a fist and note the protusion of the MCP joints. Next test for proximal myopathy and look for axillary hair. Next move to the eyes looking for diabetic eye changes before going to the chest noted a lack of chest hair, gynaecomastia and a lack of muscle bulk.
Next examine the cardiovascular system, looking in particular for the JVP, apex beat and any added hear sounds. Percuss for pleural effusions feel for sacral oedema and listen to the lung fields. Next examine the abdomen for hepatosplenomegaly/ portal hypertension and ascites and finally ask to check for testicular atrophy.
The important thing to remember here is that the disease can affect the heart (failure), liver (cirrhosis), joints (arthropathy), hypothalamus (hypopituatry) and pancreas (diabetes).