Hepatomegaly – Abdominal Examination (Detailed + Clinical Tips)
Comprehensive abdominal examination findings in a patient with hepatomegaly — detailed for case presentation and OSCE preparation.
General Inspection
The patient is lying comfortably, with no acute distress. Mild jaundice may be visible in the sclera or skin. Hands may show palmar erythema or spider nevi, suggesting chronic liver disease. No tremors or flapping are noted.
Inspection of the Abdomen
Mild fullness in the right hypochondrium is noted. Abdominal movements with respiration are reduced on the right side. No scars, veins, or visible masses are observed. The umbilicus remains central and inverted.
Palpation
The liver edge is palpable below the right costal margin in the midclavicular line. It moves with respiration, has a smooth, firm surface, and is non-tender. The spleen is not palpable, and no ascites is present.
- Liver span measurement
- Liver span is measured along the midclavicular line using a tape measure and percussion. Normal span: 6–12 cm. In this case, the span is increased to approximately 14 cm.
- Edge and surface
- Edge smooth and sharp, surface regular — suggesting benign or congestive enlargement.
Percussion
The upper border of liver dullness begins at the 5th intercostal space, with the lower border extending below the costal margin. The span confirms hepatomegaly. No shifting dullness or free fluid is noted.
Auscultation
Normal bowel sounds heard. No hepatic bruits or friction rubs detected.
Always describe the surface, edge, consistency, tenderness, and respiratory movement of the liver.
Benign hepatomegaly: Smooth surface, sharp edge, firm consistency, moves with respiration, non-tender.
Malignant hepatomegaly: Irregular or nodular surface, hard consistency, rounded edge, fixed or restricted movement, may be tender.
Use a measuring tape and percussion to determine liver span — normally 6–12 cm in the midclavicular line. Record enlargement accurately for follow-up comparison.
Comments
Post a Comment