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Gastro Exam
 
 

Liver Palpation

 
 
 
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Overview

Palpation of the liver can be used to assess the liver span and consistency, as well as for tenderness over the liver or gallbladder.

Hepatomegaly

  • Feel For

  • The size of the liver, by estimating the location of the upper and lower liver edges.
  • How to Elicit

  • Percussion of upper liver edge - Percuss down the midclavicular line from the level of the third rib, with the struck finger held horizontal to the ribs. Once the top edge of the liver is percussed the percussion note will become dull.
  • Scratch test for lower liver edge - Place the stethoscope over the liver just above the costal margin. Gently scratch the lower abdomen in the midclavicular line and slowly move up. Once the finger scratches over the lower liver edge the sound will be transmitted to the stethoscope.
  • Percussion of upper liver edge - Percuss down the midclavicular line from the level of the third rib, with the struck finger held horizontal to the ribs. Once the top edge of the liver is percussed the percussion note will become dull.
  • Interpretation

  • Normal female liver - 8-10cm
  • Normal male liver - 10-12cm
  • Hepatomegaly - >15cm
  • Causes of Hepatomegaly

  • Congestion - congestive cardiac failure, hepatic vein thrombosis, cirrhosis
  • Hepatitis - alcoholic liver disease, non-alcoholic steatohepatosis, hepatitis, drug-induced
  • Metabolic liver disease - amyloidosis, haemochromatosis, Wilson’s disease
  • Cancers - liver, stomach, pancreas, lung, colorectal, melanoma
  • Infection
  • Haematological - leukaemia / Hodgkin lymphoma
  • Diaphragmatic depression - emphysema, pleural effusion

Liver Nodularity

  • Feel For

  • The consistency of the liver, assessing for nodules.
  • Causes of Liver Nodularity

  • Cirrhosis
  • Malignancy - hepatocellular carcinoma, liver metastases
  • Polycystic liver - due to polycystic kidney disease, or isolated polycystic liver

Murphy’s Sign

  • How to Elicit

  • Palpate the right subcostal area, and ask the patient to take a deep breath in. The sign is positive if pain is reproduced when the (inflamed) gallbladder comes in contact with the examining hand.
  • Significance

  • An indicator of acute cholecystitis.
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