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Viscera
----- liver
palpate liver at
To
midclavicular and
midsternal lines
Method: The right hand may be
held either parallel or
perpendicular to the long axis of
the patient. In the
midclavicular starting at the
anterior superior iliac crest,
examiner presses down firmly
and asks patient to inhale
deeply. This allows the liver to
move down to meet your
fingertips.
√ If you feel nothing, press up a
few centimeters toward the rib
cage and repeat the maneuver.
Do this continuously until you feel
the liver or reach the coastal
margin.
√ Normally the liver is not
palpable, but sometimes the
examiner may feel the edge
of the normal liver at or
slightly below the right costal
margin.
√ When the liver is palpated,
a firm edge will strike the
fingers upon inspiration.
√ In the midsternal line, from
the level of the umbilicus, repeat
the above maneuvers to palpate
the liver.
√ Most doctors like to use
bimanual maneuvers to palpate
the liver. To do this, place the left
hand at right lower posterior chest
wall parallel to, or supporting
patient’s right 11-12th ribs or at
lower sternal area to limit the
chest respiration to make right
hand palpation more effective.
Note:
( 1 ) When felt more than 2cm.
below the costal margin, however,
the organ should be considered
abnormally large.
large right lobe of the liver,
which occasionally extends quite
far into the right flank.
√ Another exception is seen in
severe, chronic emphysema( 肺
气肿 ), in which the diaphragms
are depressed by the
overexpanded lung, displacing
the liver below the costal
margin.
In both instances the total mass
of the liver is within normal
limits.
( 2 ) If you feel the liver, detect
the edge (sharp or round), tender or
not, hard or soft and repeat the
process laterally and medially to
define the contour. For masses
within the liver, describe the same
characteristics as above and listen
for a bruit over the mass.
Size