Percussion:
Liver
Liver span
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The liver span is estimated by percussion.
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Remember that it is easier to hear the change from resonance to dullness – so proceed with percussion from areas of resonance to areas of dullness.
Upper border: In the midclavicular line start percussing in the chest moving down towards the abdomen about ½ to 1 cm at a time. Note where the percussion notes change from resonate to dull.
Lower border: In the midclavicular line begin percussion below the unbillicus and proceed upward until dullness is encounter.
- The distance between the two areas where dullness is first encountered is the liver span.
- Liver span is normally 6 to 12 cm in the midclavicular line.
- Is there ascites?: Abdominal distension, flank dullness with shifting dullness?
Spleen
Examine the spleen Is the spleen enlarged? Is it palpable below the left costal margin? Begin in right iliac fossa and palpate towards left costal margin. Measure. Define the upper extent by percussion. Is it tender? Bruit?
Does it move with respiration?
Are there any other signs of portal hypertension e.g. ascites, caput
medusae, distended veins (determine direction of flow)?
Examining the patient with lymphadenopathy and/ or splenomegaly.
Kidney
Examine the kidneys
- Are the kidneys palpable? Ballottable? Smoothly or irregularly
- enlarged (consider polycystic kidney disease), bruits?
Ascites
