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CAUSES OF A8N0RMAL LtVER SI2E

o FLAPPING TREMOR

Jerky forward morements every 2-3 seconds when arms are outstretched and hands are dorsiftexed.

0 PALPATION OF THE ABDOMEN

Livcr

•    Start in the right iliac fossa.

•    Progress up the abdomen 2 cm with each breath (through open mouth)

•    Confirm the lower border of the liver by percussion (see 6).

•    Detect if smooth or irregular. tender or non-tender; ascertain shape.

•    Identify the upper border by percussion (see 6).

Large lim (hepatomegaly)

•    Liver metastases

•    Cirrhosis

AJcohoi

Kaemochromatoss

•    Hepatic venous outnow obsiruction

Smali lim

• Cirrhosis

Auiołnmutw lim dtsease Alpha ,-antitrypsin defidcncy Cryptogenic

CAUSES Of ASCITES
High protein (exudative)
• Carcinoma
• Tuberciiosis
Low protein (transudative)
• Congestrvc heart faiiure
• Renal faiiure (induding
nephrotic syndrome)
• Cirrhosis

0 PERCUSSION OF THE ABDOMEN

Liver

•    Ahvays start percussion from resonant to duli; i.e. percuss lower border from benoath and upper bordor from above.

•    Percuss the abdomen gently. the chest morę firmly.

•    Once the upper border of tho liver is idontified. confirm its position by counting down the ribs from the sternal angle (second mtercostai space).

Shifting dullncss

•    Start around the umbilicus (resonant).

•    Percuss at 1 cm intorvals around to the left flank.

Spleen

•    Start again in the right iliac fossa.

•    Progress towards the left upper quadrant at 2 cm intervais.

•    Place the left hand around the lower laterai ribs as the costal margin is approached.

• Notę the charactenstics of the spleen

-    Notch

-    Superfioal

-    CHJI to percussion

-    Cannot get between ribs and spleen

-    Moves wen with respiration.

•    identify where duiiness occurs.

•    Roli the patient on to the left-hand side and notę if the level of dudness moves towards the umbilicus.

© Elsevier. Boon et al.: Davidson's Principles and Practice of Medicine 20e - www.studentconsult.com