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notre dame

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hepatomegaly

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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

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Convex surfaces

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Coronal ligaments attach to

diaphragm

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Concave surfaces

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diagnosis

History

Physical examination

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Physical examination

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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?

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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.

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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

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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

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below the costal margin however

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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

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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.

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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

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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

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Differetial diagnosis

Pulsatile liver

Fatty liver and nonalcoholic steatohepatitis

(NASH)

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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

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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

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