How to examine the liver?

Examining the liver involves physical palpation to assess its size, shape, consistency, and tenderness.

Here's how to perform a liver examination, incorporating techniques based on the provided reference:

Liver Palpation Technique

The primary method for examining the liver at the bedside involves palpation. Here's a step-by-step guide:

Patient Positioning: Have the patient lie supine (on their back). This position allows for optimal access to the abdomen.
Hand Placement: Place your right hand on the patient's abdomen, just lateral to the rectus abdominis muscle. This placement should be well below the expected lower border of liver dullness. Starting low avoids missing an enlarged liver that extends further down.
Deep Breath: Ask the patient to take a deep breath in and hold it. This maneuver causes the liver to descend as the diaphragm contracts.
Feel for the Liver Edge: As the patient inhales, try to feel the edge of the liver as it descends. Apply gentle pressure with your fingers.
Assess Texture: If you feel the liver edge, be sure to allow the liver to pass under the fingers of your right hand. Note the texture. Is it smooth, nodular, or tender?

Patient Comfort: Ensure the patient is comfortable and relaxed throughout the examination. Distraction techniques or gentle conversation can help ease any anxiety.
Pain Assessment: Ask the patient about any pain or tenderness during palpation. Note the location and severity of any discomfort.
Breathing Technique: Encourage the patient to breathe slowly and deeply. This will maximize the descent of the liver.
Document Findings: Accurately document all findings, including liver size, consistency, tenderness, and any other relevant observations.

By following these steps and considerations, you can effectively examine the liver and gather valuable information for diagnosis and treatment.