Liver span 14 cm. with firm edge. Well healed midline surgical scar from xiphoid to umbilicus. Well healed right subcostal surgical scar. Moderate tenderness to deep palpation LLQ, without rebound. Involuntary guarding present.
Hyperactive bowel sounds.
AK amputation on left. 3 x 3 cm. ulcer over left lateral malleolus with purulent discharge. Joints Erythema, swellinq, and tenderness of PIP joints of hands bilaterally. Swelling, heat, and tenderness of right knee with limited range of motion and ballotable effusion. Swelling with tense effusion of left knee.