Examining the Liver

00:00 angle tenderness. Next thing I want to do is feel out for the liver. How do we do that? Ask them to breath in and as they breath in, you’d put your fingers through and it will tap against them. Perfect! So I’m just going to let the patient know. I’m just going to see if I can feel the side of your kidney, and I’m going to start here, just above your hip, okay. What I’d like you to do is take some deep breath in and out. Breathe in, good, and breathe out. Again, breathe in and out. Essentially, what you’re doing is pushing in as the patient breath in, and you’re trying to catch that liver edge as it goes past. Okay. You do the same for this spleen, where would you start? Same place, yeah. Remember, if you can feel any enlarged spleen, it’s an enlarged spleen. It has to be about three times the size which we’d be able to palpate it. So again, you start from here. You’re getting the patient to take breathe in and out and go all the way across. If it was a woman and she was potentially gravid, you may also feel for a uterus as well, and you can also palpate for the body. Okay.

01:03 But I won’t do that because you might want to rush in the bathroom. What would you do after palpation? Percussion? Yeah, absolutely. I’m going to just have a quick tap on you, Tommy, if that’s alright? So again, I’m looking at his face and I’m going to systematically, across all nine quadrants. What is this useful for? Ascites.

01:28 Yeah, ascites. So it’s checking to see if there’s any fluid. What would you hear if it was fluid? Shifting dullness.

01:38 Absolutely. So it’s quite an important sign that you need to elicit as well. So, what would you do in that case if you just saw any abdominal distension that you wanted to see if there was any fluid there? You’d start from the centre and percuss out.

01:51 And then if you got to the point where your resonant percussion note became a dull percussion note, keep your finger on there and you’d ask the patient to roll over to the side.

01:58 So, can I get you to roll over to the side? Please don’t fall off the couch. Great! Keeping your finger in the same place and you’d say to them I’m going to keep you like this for about 30 seconds. If I can demonstrate that this dull percussion note has gone to a resonant percussion note, then I’ve demonstrated shifting dullness.

02:14 That’s fine. Can I get you to lay back? We can also percuss out the borders of the liver and the spleen as well. I’m going to go onto auscultation. So just explain to