Palpation: Liver Exam Techniques

Study Notes

Palpation Techniques

Liver Palpation

Front hand placed flat, fingers upwards, lateral to the rectus muscle.
Firm inward and upward pressure is applied; keep hand steady during patient's deep breath.
Release inward pressure at inspiration's peak; maintain upward pressure.
Tips of fingers should slide over the liver's edge, which is typically sharp and flexible.
Assess for firmness, irregularity, and tenderness during palpation.

Spleen Palpation

Utilize bimanual technique: one hand supports tissue in the left renal angle.
Front hand flat over left hypochondrium; can detect a large spleen through a forward movement of the back hand.
When spleen's tip is just below costal margin, press upwards towards left axilla.
During deep inspiration, a palpable enlarged spleen will touch the fingertips.

Signs of Splenomegaly

Fingers may reach beneath the anterior edge and lower pole.
Inability to insert fingers between spleen and costal margin indicates enlargement.
Observations include scaphoid (due to various health conditions) and protuberance (linked to obesity, distension, pregnancy).

Abdominal Examination Techniques

Inspection of Contours

Dome-shaped swelling above pubis indicates pelvic organ enlargement (bladder, uterus).
Ascites presents as bulging flanks.
Gastric distention appears as upper abdominal bulging; confirmed by gastric peristalsis and succussion splash.

Hernial Orifices Inspection

Visible impulse or swelling when coughing suggests hernia presence.

Palpation Procedures

Warm hands are essential; start at a remote site from pain.
Patient's facial response can indicate tenderness.
Use flat hand rather than fingertips; light and deep palpation methods are key.

Abdominal Mass Characteristics

Evaluate site, size, shape, color, temperature, tenderness, mobility, consistency, and surface texture.
Caudal movement on inspiration suggests the mass is intra-abdominal; structure movement indicates attachment.

Male Genital Examination

Inspection

Assess pubic hair distribution, penis appearance/size, prepuce condition, urethral meatus location, and scrotal skin for abnormalities.
Note whether both testes are descended and inspect scrotum's posterior surface.

Penis Palpation

Check corpora cavernosa for induration; retract prepuce.
Common conditions include phimosis, balanitis, hypospadias, and epispadias; symptoms vary by condition.

Scrotal and Testis Palpation

Inspect scrotal skin for cysts or ulcers; palpate testis for size, consistency, nodules.
Atrophy can be indicated by bi/unilateral testicular size changes; check for undescended testes.

Epididymis and Spermatic Cord Palpation

Evaluate head and tail of epididymis for cysts or infection.
Assess for varicocele and torsion; determine the nature of scrotal swelling through palpation techniques.

Rectal Examination

Indications for Digital Rectal Exam

Complete all abdominal exams with a digital rectal assessment.
Useful for diagnosing alimentary and genitourinary problems, unexplained weight loss, etc.

Examination Procedure

Position patient on left side; ensure relaxation and awareness of the procedure.
Use gloves, lubricant, inspect perianal area for signs of abnormalities like dermatitis or fissures.

Rectal Findings

Evaluate anal sphincter and wall, search for masses; observe finger after withdrawal for blood and fecal sample color.

Key Observations

Movements during inspiration can help differentiate between intra-abdominal masses and structures fixed to the abdominal wall.
Scrotal swelling characteristics can indicate various underlying conditions requiring further investigation.

Description

This quiz focuses on the technique of palpating the liver, essential for assessing abdominal health. It covers proper hand placement and pressure during the examination as the patient breathes deeply. Mastering this skill is crucial for medical professionals in their practice.

Palpation: Liver Exam Techniques

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Questions and Answers

What is the main focus when palpating the liver during a physical examination?

During deep inspiration, how should the pressure be applied when palpating the liver?

What is a key indicator of splenomegaly during palpation?

How should the palpating hand be positioned when examining the spleen?

What characteristic of the liver edge should be noted during palpation?

Which condition is indicated by a dome-shaped central swelling rising above the pubis?

What does the presence of a succussion splash confirm during inspection of gastric distension?

Which of the following is NOT typically assessed during light palpation of the abdomen?

What can be observed at a hernial orifice during inspection?

When palpating the abdomen to assess for an abdominal mass, which characteristic is NOT typically analyzed?