Liver Exam Flashcards
4 “areas” of inspection for liver exam
- head
- skin
- hands
- centrral abdomen “central signs”
head inspection
- yellowing of eyes; scleral icterus
2. jandiced frenulum
hands inspection
- thenar atrophy
- palmar erythema
- clubbing; absence of shamroths sign
- leukonychia
- terry’s nails
- dubutryns contractures
- asterixis
skin inspection
- jaundice
- telangiectasia
- wasting/cachectic look
- spider nevi
- petechiae
- if males; gyencomastia
- if males; testicular atrophy.
- EDEMA; pitting or obvious swelling
central signs in abdomen
- masses- obvious bulging
- ascites; symmetry, distension, or bulging flanks
- jaundice, telangiectasia, spider nevi, wasting
- caped medusae
- scars
- prominent veins and CAPUT MEDUSAE
- skin breakdown secondary to scratching (pruritus)
- umbilical hernia
after the 4 aspects of inspection, what is next?
percussion
- percuss from chest down mid clavicular line until you hear dullness;; top of liver
- percuss up from RLQ to find lower border
- should be 12 cm in males and 10 cm in females
what test can you do if you cannot percuss liver normally?
scratch test with obese individuals or severe ascites. place the diaphragm of stethoscope just above the right costal margin at the mid clavicular line– with your mail, lightly scratch the skin of the abdomen along the mid clay line, moving from below the umbilicus toward the coastal margin. when your scratching finger reaches the liver edge, you will hear the scratching sound as it passes through the liver to the stethoscope
after percussion is palpation. outline what you would do
recall that the liver will not be easily palpated if it is normal size.
- support the ribs on the right side with your left hand and use your right hand to palpate for liver.
- START PALPATING IN RLQ AND MOVE TOWARDS THE RIGHT COSTAL MARGIN.
- while palpating, ask the patient to take deep breaths in and out through their mouth.
- advance your palpating hand on expiration and make sure that it is in place by the time the patient takes a breath in. as the patient breaths in the diaphragm depends and pushes the liver down on it. If the liver is enlarged you may feel the edge of it push against your finger tips when the patient breaths in .
- describe the liver edge in terms of texture, tenderness, pulsality, regularity and nodularity
how should you describe the liver on palpation
describe the liver in terms of tenderness, regularity, nodularity, pulsality, texture
after palpation what should we do?
auscultation, listen over any bruits.
two types of liver special test
- shifting dullness test
2. fluid wave test/ fluid thrill test
after auscultation for bruits, what Is the next step
special test
1. fluid wave test: get the patient to put their hand lengthwise on their abdomen to prevent tissue movementt. support the right abdomen with your hand while pressing on the other side. if there is ascites, you will feel the wave on the left hand
- shifting dullness test
- percuss on the umbilicus and then move laterally. if fluid was present, it would settle to the lateral flanks because of gravity. then turn the patient on their side and perform the same maneuver. the fluid should shift upwards.
