EXAMINATION OF THE LIVER

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EXAMINATION OF THE LIVER R. MICHAEL RODRIGUEZ,
M.D. ASSOCIATE PROFESSOR OF MEDICINE VANDERBILT
UNIVERSITY SCHOOL OF MEDICINE
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METHODS OF EXAMINING THE LIVER

• PERCUSSION
• PALPATION
• SCRATCH TEST
• AUSCULTATION

JAMA 19942711859 1865 ANN INT MED
1969701183-1189
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LIVER SPAN
MCL
PERCUSSION
NL lt 12-13 CM
2-3 CM DURING INSPIRATION AND EXPIRATION COPD
PALPATION PERCUSSION SCRATCH TEST
LIVER SPAN MAY VARY BETWEEN OBSERVERS DEPENDING
UPON WHERE THE MCL IS DETERMINED
JAMA 19942711859-1865
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LIVER SPAN - PERCUSSION
AIR
RESONANCE
DULLNESS
CONSIDER USING MULTIPLE PLEXIMETERS
JAMA 19942711859-1865
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AUSCULTATION UNCOMMON FINDINGS

• FRICTION RUBS - MALIGNANCY, HEPATOMAS, LIVER
  ABCESS
• HUMS (SYSTOLIC AND DIASTOLIC) PORTAL
  HYPERTENSION
• BRUITS (SYSTOLIC) TUMORS, ETOH HEPATITIS

JAMA 19942711859 -1865 JAMA 1979241495
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PALPATION
FLEX KNEES AND HIPS IF POSSIBLE BEGIN LOW ON
ABDOMINAL WALL AND MOVE HAND CEPHALAD, HAVE
PATIENT TAKE A DEEP BREATH NOTE CONSISTENCY
(NODULES, SMOOTH) AND CONTOUR IF THE LIVER EDGE
IS FELT NOTE IF THERE IS ANY PAIN WITH
PALPATION AUSCULTATE
MOSBYS GUIDE TO THE PHYSICAL EXAMINATION, 3RD
ED. 1995
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HOOKING THE LIVER
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SCRATCH TEST
MOVEMENT
BEGIN
USED TO IDENTIFY THE INFERIOR BORDER OF THE
LIVER STETHOSCOPE IS PLACED OVER THE LIVER IN THE
MCL SCRATCHES ARE PRODUCED BEGINNING IN THE RLQ
AND MOVING THE FINGER CEPHALAD IN THE MCL. A
CHANGE IN THE UNDERLYING TISSUE (INFERIOR LIVER
EDGE) IS IDENTIFIED BY THE CHANGE IN SOUND
INTENSITY.
MOSBYS GUIDE TO PHYSICAL EXAMINATION 3RD ED,1995
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SUMMARY

• WHEN EXAMINING THE LIVER LOCATE THE LOWER LIVER
  EDGE FIRST
• PERCUSS OR USE THE SCRATCH TEST TO AID IN
  IDENTIFYING THE LOWER LIVER EDGE
• PERCUSS LIVER SPAN IN THE MCL
• KNOW THE PITFALLS