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Examination of the abdominal system
Published in Tracy Lapworth, Deborah Cook, Clinical Assessment, 2022
Percuss both the upper and lower borders to determine the span of the liver:To identify the upper border, start percussing on the right side in the midclavicular line in an area of resonance until the note changes to dullnessThis may be difficult in women with large breasts. You can start percussion under the breast tissueTo identify the lower border, start percussion in the right midclavicular line below the umbilicus and percuss up, from tympani to dullnessMeasure the span in centimetres. In an adult, the liver span is normally 6–12 cm
Clinical examination
Published in Nicholas Summerton, Primary Care Diagnostics, 2018
Clearly this is not an exhaustive list but it serves to illustrate and highlight some of the available evidence. Gastric problems (e.g. peptic ulceration), pancreatitis and a range of other possibilities also may need considering along similar lines. More generally, some workers have sought to assess the accuracy of the examination of the abdominal organs as well as the detection of ascites. Unfortunately, finding an enlarged spleen or an enlarged liver by percussion or palpation is neither particularly valid or reliable.19,20 Even if a clinician palpates a liver edge extending below the costal margin this does not necessarily indicate hepatomegaly (LR+ = 1.7) and to assess the liver span by percussion is very unreliable (kappa = 0.11, poor agreement). A palpable spleen does argue in favour of splenomegaly (LR+ = 9.6) and the level of interobserver agreement of the finding ranges from a kappa of 0.56 to 0.70 (moderate to substantial agreement) but, unfortunately, many enlarged spleens are impalpable.
Gastroenterology and hepatology
Published in Fazal-I-Akbar Danish, Essential Lists of Differential Diagnoses for MRCP with diagnostic hints, 2017
Reduced liver span (normal 12–15 cm):1 Advanced cirrhosis.2 Fulminant hepatitis.3 Air under the diaphragm, e.g. secondary to rupture of a hollow viscus.
The clinical features and outcomes of systemic light chain amyloidosis with hepatic involvement
Published in Annals of Medicine, 2022
Liang Zhao, Guisheng Ren, Jinzhou Guo, Wencui Chen, Weiwei Xu, Xianghua Huang
The median age of 88 patients was 55 years, and 73.9% of them were males. The most common clinical manifestations were edema, and 78 (88.6%) patients showed different degrees of edema; digestive symptoms were observed in 59 (67.0%) patients, including anorexia, abdominal distention, diarrhoea, nausea and vomiting; weight loss appeared in 51 (58.0%) patients with an average weight loss of 7.2 kg at diagnosis; fatigue was manifested in 49 (55.7%) patients; congestive heart failure was found in 12 patients (13.6%). Liver enlargement was found in 49 (55.7%) patients and splenomegaly in 12 (13.6%) patients. The median liver span was 135 mm (IQR 119, 157). The median AKP was 415 U/L (IQR 308, 574). The median serum bilirubin level was 9.7 umol/L (IQR 6.3, 15.4). Forty-six patients (56.8%) presented with ascites. Spontaneous splenic rupture occurred in one patient, he underwent splenectomy and HDM/ASCT successively and survived until the follow-up deadline.