Date post: | 30-May-2018 |
Category: |
Documents |
Upload: | dinmanrituraj1683 |
View: | 218 times |
Download: | 0 times |
of 29
8/14/2019 Teaching Plan 5
1/29
notre dame
8/14/2019 Teaching Plan 5
2/29
hepatomegaly
8/14/2019 Teaching Plan 5
3/29
8/14/2019 Teaching Plan 5
4/29
Normal liver
its lower edge comes just to the lower edge
of ribs ( costal margin )on the right side
The edge: thin, firm, cannot be palpatedbelow the edge of costal margin
1500g
8/14/2019 Teaching Plan 5
5/29
8/14/2019 Teaching Plan 5
6/29
Convex surfaces
8/14/2019 Teaching Plan 5
7/29
Coronal ligaments attach to
diaphragm
8/14/2019 Teaching Plan 5
8/29
Concave surfaces
8/14/2019 Teaching Plan 5
9/29
8/14/2019 Teaching Plan 5
10/29
8/14/2019 Teaching Plan 5
11/29
8/14/2019 Teaching Plan 5
12/29
8/14/2019 Teaching Plan 5
13/29
diagnosis
History
Physical examination
8/14/2019 Teaching Plan 5
14/29
Physical examination
8/14/2019 Teaching Plan 5
15/29
8/14/2019 Teaching Plan 5
16/29
history
Is there any unusual-colored or paled-
colored stools?
Have you had any fevers?
What medications are you taking?
How much alcohol do you consume?
8/14/2019 Teaching Plan 5
17/29
Method: The right hand may beheld either parallel or
perpendicular to the long axis ofthe patient. In themidclavicular starting at the
anterior superior iliac crest,examiner presses down firmlyand asks patient to inhale
deeply. This allows the liver tomove down to meet yourfingertips.
8/14/2019 Teaching Plan 5
18/29
few centimeters toward the ribcage and repeat the maneuver.
Do this continuously until you feelthe liver or reach the coastalmargin.
Normally the liver is notpalpable, but sometimes theexaminer may feel the edge of
the normal liver at or slightlybelow the right costal margin. When the liver is palpated, a
firm edge will strike the fingers
8/14/2019 Teaching Plan 5
19/29
the level of the umbilicus, repeatthe above maneuvers to palpate
the liver. Most doctors like to usebimanual maneuvers to
palpate the liver. To do this,place the left hand at right lowerposterior chest wall parallel to, or
supporting patients right 11-12thribs or at lower sternal area tolimit the chest respiration to
make right hand palpation more
8/14/2019 Teaching Plan 5
20/29
8/14/2019 Teaching Plan 5
21/29
..\..\\.rm
below the costal margin however
http://../??????\?????.rmhttp://../??????\?????.rmhttp://../??????\?????.rmhttp://../??????\?????.rmhttp://../??????\?????.rmhttp://../??????\?????.rmhttp://../??????\?????.rmhttp://../??????\?????.rmhttp://../??????\?????.rmhttp://../??????\?????.rmhttp://../??????\?????.rmhttp://../??????\?????.rm8/14/2019 Teaching Plan 5
22/29
below the costal margin, however,the organ should be consideredabnormally large.
An exception is a congenitallylarge right lobe of the liver, whichoccasionally extends quite far into
the right flank. Another exception is seen insevere, chronic emphysema( ), in which the diaphragms aredepressed by the overexpandedlung, displacing the liver below thecostal margin.
In both instances the total mass of
8/14/2019 Teaching Plan 5
23/29
2 If you feel the liver, detectthe edge (sharp or round), tender ornot, hard or soft and repeat theprocess laterally and medially to
define the contour. For masseswithin the liver, describe the samecharacteristics as above and listenfor a bruit over the mass.
8/14/2019 Teaching Plan 5
24/29
Features of hepatomegaly
Palpable below the right costal margin ( in
gross hepatomegaly, it may extend to the
left costal margin)
Downward movement on insiration
Dullness to percussion
8/14/2019 Teaching Plan 5
25/29
Characteristic of the liver
Size
Consistancy: hard, film
Definition of liver edge:smooth, knobblyTenderness: engorged liver in right heart
failure
Pulsatility: as in tricuspid stenosis
8/14/2019 Teaching Plan 5
26/29
Differetial diagnosis
Pulsatile liver
Fatty liver and nonalcoholic steatohepatitis
(NASH)
8/14/2019 Teaching Plan 5
27/29
Pulsatile liver
Liver move with arterial pulsation
Expansile pulsation: Placing the hands on
opposite sides of liver and observing that
the surfaces move apart in systole
Tricuspid insufficiency is the usual cause
8/14/2019 Teaching Plan 5
28/29
Fatty liver and nonalcoholic
steatohepatitis (NASH)
Increased accumulation of fatin hepatocytes
Associated with: obesity,
hypertriglyceridemia, diabetes, older age
Symptomatic in early stage
Later :cirrhosis, signs and symptoms of portal
hypertension, hepatic insufficiencyTransaminases may or may not be elevated
8/14/2019 Teaching Plan 5
29/29