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Gastro Exam

 
 
 
The Patient
The Hands
The Arms
The Face
The Neck
The Chest
The Abdomen – Inspection
The Abdomen – Auscultation
The Abdomen - Palpation
The Groin
Digital Rectal Examination
 
 

Liver Palpation

 
 

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.
    • 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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Associated Diseases
BETA

Gastrointestinal
Haematology
Nutrition & Metabolic
Other
 
Read More...
Tingle LE, Molina D, Calvert CW. Acute pericarditis. Am Fam Physician. 2007 Nov 15;76(10):1509-14.
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