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Haem Exam

The Liver

February 15th, 2021


  • Feel For

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

  • 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, fatty, hepatitis, drug-induced
  • Metabolic liver disease - amyloidosis, haemochromatosis, Wilson's disease
  • Cancers - liver, stomach, pancreas, lung, colorectal, melanoma
  • Infection - acute
  • Haematological - leukaemia / Hodgkin lymphoma
  • Diaphragmatic depression - emphysema, pleural effusion

Liver Consistency

  • Feel For

  • The consistency of the liver.
  • Interpretation

  • Smooth enlargementCongestion, acute hepatitis, fatty liver, leukaemia / lymphoma
  • Firm ± enlargementChronic hepatitis, cirrhosis
  • Nodular enlargementHepatocellular carcinoma, metastatic carcinoma
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