|
Abdominal Examtion of the Liver and its Palpation for medical students.
Abdominal Examtion of the Liver and its Palpation
In the healthy adult, as a rule, only the left lobe of the liver can be felt by the palpating hand, giving rise to a slight feeling of resistance in the epigastric region.
On very deep inspiration, however, the edge of the right lobe may sometimes be made to project so far beyond the costal margin as to offer appreciable resistance to the fin gers. In children the liver is of such size as to be readily examined by palpation.
Either as a result of enlargement or of lowered position (due, for example, to the downward pressure of a pleural effusion), the liver may come within reach of the palpat ing hand, and then we have to examine the condition of its surface, the consistence of the organ, its size and general shape.
The surface of the liver may be smooth or rough. In amyloid and fatty degeneration, and in congestion, the sur face ot the swollen organ is smooth, a condition which is very readily recognized by palpation. In the case of cirrho sis, the uneven granular surface gives rise to a character istic feeling of roughness when the abdominal wall is made to glide backwards and forwards over the surface of the liver.
More marked irregularities of surface are found in carci noma, the distinct nodules of which can be felt, and occa sionally the umbilications which these nodules present.
Tenderness on pressure is met with in congestion and in all inflammatory affections of the liver, such as hepatic abscess, cirrhosis, catarrh of the bile ducts. In carcinoma it is often a very marked feature, .although even in this affec tion it may be absent. There is usually no tenderness in the case of the waxy and the fatty liven Consistence of the liver is somewhat increased in fatty de generation, still more so in congestion, and to a very marked degree in waxy disease, when the lower edge may assume an almost knife-like sharpness. The presence of fluctuation will usually suffice to distinguish a hydatid tumor or an abscess from a solid growth.* The size of the liver varies greatly. In some cases, as in acute yellow atrophy, the organ recedes so far into the con cavity'of the diaphragm as to be out of reach of palpation.
In other instances (congestion, waxy degeneration, etc.) the lower edge may be found as low as the symphysis pubis.
It must be carefully borne in mind that the position of the lower border is no safe guide to the size of the liver unless it be taken aiong with the position of the upper margin as ascertained by percussion.
Abnormalities in Shape. The practice of tightlacing not only forces the liver downwards, but also frequently so com presses the hepatic substance as to give rise to a deep fur row marking off the lower portion of the right lobe. This furrow can be readily detected by palpation. 'Still more obviously is the shape altered by the presence of a large tumor, cancerous or hydatid. Growing from some partic ular part of the organ. It is most important to remember that hepatic tumors rise and fall with the respiratory move ments, which is not the case with growths in the stomach, omentum, pancreas, colon, or kidney, unless they have become adherent to the liver.
Occasionally the gall bladder may be felt as a small pear shaped tumor projecting from beneath the lower edge of the liver. Pressure, by emptying it of bile, may cause it to disappear, and in rare cases the presence of gall-stones in the bladder may be ascertained by palpation.
Related Medical Articles
Link to this Page!
|
Physical Examination Skills 
