Makindo Medical Notes

Related Subjects: |Breast Anatomy and Examination (OSCE) |Shoulder examination(OSCE) |Testicular examination(OSCE) |Hernia Examination (OSCE) |Rectal examination (OSCE) |Liver Examination (OSCE)

Overview of Liver Examination

The liver examination is a vital component of the abdominal assessment. It helps evaluate the liver's size, consistency, and tenderness, and can reveal hepatomegaly, liver masses, or tenderness indicative of underlying liver disease.

Preparation

• Privacy & Consent: Ensure the patient’s privacy and obtain informed consent.
• Explanation: Explain the procedure clearly and answer any questions the patient may have.
• Positioning: Have the patient lie supine with arms comfortably at their sides, and ensure proper exposure of the upper abdomen.

Inspection

• Examine the abdomen for any visible masses, asymmetry, or distension.
• Look for external signs of liver disease, such as jaundice, spider naevi, palmar erythema, or ascites.

Palpation

• Positioning: Stand on the right side of the patient.
  • Begin palpation in the right iliac fossa and move upward toward the right costal margin.
  • Instruct the patient to take a deep breath and, with each inhalation, advance your hands toward the right upper quadrant.
  • Feel for the liver edge as it descends on inspiration.
  • Assess the liver edge for its texture (smooth vs. irregular), tenderness, and consistency (soft vs. firm/hard).

Percussion

• Determining Liver Span:
  • Start percussion at the right midclavicular line, beginning in the lung field where resonance is present.
  • Move downward until dullness is detected, marking the upper border of the liver.
  • Percuss upward from the right iliac fossa in the midclavicular line until dullness is encountered, marking the lower border of the liver.
  • Measure the distance between these two points; a normal liver span is approximately 6–12 cm in the midclavicular line.

Auscultation

• Listen over the liver area for any bruits that may indicate vascular abnormalities (e.g., hepatic artery aneurysm or arteriovenous malformation).
• Auscultate for friction rubs, which could suggest perihepatitis or other peritoneal inflammations.

Common Findings

• Normal:
  • The liver edge is either not palpable or is felt just below the right costal margin, with a smooth and soft texture.
  • Percussion demonstrates a liver span of 6–12 cm in the midclavicular line.
• Abnormal:
  • Hepatomegaly: A liver palpable more than 2 cm below the costal margin.
  • Nodular or Irregular Edge: Suggestive of cirrhosis or liver tumors.
  • Tenderness: May indicate hepatitis, liver abscess, or congestion (e.g., due to heart failure).
  • Bruits/Friction Rubs: May point to vascular abnormalities or peritoneal inflammation.

Documentation

• Record the following in the patient’s medical notes:
  • Liver size (in cm below the costal margin and measured liver span).
  • Texture, consistency, and tenderness of the liver edge.
  • Presence of any bruits or friction rubs.
  • Associated findings such as jaundice, ascites, or other signs of liver disease.

Patient Education

• Explain the significance of the findings in simple terms.
• Discuss any necessary further investigations (e.g., liver function tests, ultrasound) or referrals.
• Advise the patient on specific symptoms to monitor and when to seek medical attention.

Summary

A thorough liver examination involves a systematic approach of inspection, palpation, percussion, and auscultation. Effective documentation and clear patient education are essential for diagnosis and subsequent management.

Interpretation

• Hard, Irregular, and Non-Tender: Suggestive of liver cancer.
• Smooth, Firm, and Non-Tender: May indicate cirrhosis or lymphoma.
• Smooth, Tender, and Enlarged: Can be associated with congestive cardiac failure (CCF), alcoholic liver disease, or hepatitis.
• Pulsatile: May be indicative of tricuspid regurgitation.
• Hepatomegaly Causes: Common causes include metastases, cirrhosis, CCF, and lymphoma.