liver assessment

2. Topic: LIVER
Presented To: Madam Nazia Noor
Presented By: Madiha Rafique
Iram Aslam
Fehmida Haneef
Farah Shehzadi
Iram Malik
Post RN 1st Prof
Jinnah College Of Nursing, AIMC Lahore.

3. Content
Anatomy
Physiology
Examination
1.Inspection
2.Auscultation
3.Percussion
4.Palpation
LIVER

4. Liver

10. Human liver Anatomy

12. Inspection
Auscultation
Percussion
Palpation
Liver assessment Techniques:

13. Inspection:
Look for gross asymmetries across the
abdomen. Look at the skin for signs of
liver disease, such as caput medusa, or
spider angiomata

15. Auscultation:
 Follow the inspection of the liver, as with the rest of
the abdominal exam, with auscultation. Listen over
the area of the liver for bruits or venous hums.

16. Percussion:
Percuss for the upper and lower margins of
the liver. Place your non-dominant hand
palm down flat on the abdomen with the
fingers parallel to the lower costal margin
pointed toward the midline. Percuss with
the middle finger of your dominant hand on
the middle finger of your non-dominant
one.

18. Percussion cont:
 Begin percussion over the lungs and move from
the area of resonant lung sounds to the areas of
dullness. Mark the area of change. Repeat the
same process from below, moving again from
resonance over the bowel to dullness and again
mark the area of change. Start in the lower right
quadrant so as to not miss a greatly enlarged liver.
Measure the vertical distance from the top to the
bottom. You can also use palpation to determine
the lower border.

19. Palpation:
 Begin palpation over the right lower quadrant, near
the anterior iliac spine. Palpate for the liver with one
or two hands palm down moving upward 2-3 cm at a
time towards the lower costal margin. Have the
patient take a deep breath. The liver will move
downward due to the downward movement of the
diaphragm. Feel for the liver to hit the caudal aspect
of your palpating hand. Palpate the bottom margin of
the liver for the texture of the liver, i.e. soft/
firm/hard/nodular.