Practical aspects of Liver examination

Principles

Always stand on the right side of the patient(if you are right-handed)
Get the patient to lie supine on the bed
Ask the patient to flex the legs at knee joint
Expose the abdomen up to the chest and below up to the inguinal canal. Ask the patient if there is any tenderness before palpating
Ask the patient to take deep breaths. Breathe in through the nose and breath out through the mouth
You can request the patient to look to the other side -opposite to the side you are standing so that the patient doesn’t breath on your face
Rub your hands together to warn them before palpating
Always palpate the child is breathing out(expiration)

Points to note with abdominal palpation

Method to palpate the liver

Place the flat of the right palm over the right iliac fossa and press inwards and slowly move upwards
The hand is always placed parallel to the lower border of the liver
When the child takes inspirations, press the fingers firmly inwards and upwards and feel for the lower border of the liver
Once you feel the lower border, percuss the chest from 2nd intercostal space downwards at the midclavicular point.
Percuss each space downwards until you feel the dull sound.
Now you can measure the distance between the upper border dullness and lower border.

Points to note in liver enlargement

Size- enlarged or not- measurement is always taken in expirations. You can measure it as centimetres or finger breaths
Consistency- Hard or soft
Tenderness- present/ absent
Surface- smooth/irregular
Margin- smooth / rounded
Movement with respirations- Liver moves with expirations
Any pulsations- present/ absent
Hepatic bruit- place the stethoscope on the liver and hear for bruit.

Causes of Hepatosplenomegaly

Causes of tender liver

Causes of hepatomegaly with jaundice