Makindo Medical Notes

Related Subjects: |Breast Anatomy and Examination (OSCE) |Shoulder examination(OSCE) |Testicular examination(OSCE) |Hernia Examination (OSCE) |Rectal examination (OSCE) |Liver Examination (OSCE)

🧾 Overview of Liver Examination

The liver exam assesses size, consistency, tenderness and can reveal hepatomegaly, cirrhosis, malignancy, or vascular pathology. It follows the classic OSCE sequence: 👀 Inspection → ✋ Palpation → 📏 Percussion → 🎧 Auscultation.

🛠️ Preparation

• 🛑 Privacy & Consent: Ensure dignity and obtain consent.
• 💬 Explain: “I will examine your tummy, particularly your liver, by looking, feeling, tapping and listening.”
• 🛌 Position: Patient supine, arms by sides, upper abdomen exposed.

👀 Inspection

• Abdomen: distension, scars, pulsations, visible masses.
• Stigmata of liver disease:
  • Jaundice 🟡
  • Spider naevi 🕷️
  • Palmar erythema ✋
  • Ascites 🌊
  • Muscle wasting, bruising, gynaecomastia 👕

✋ Palpation

• Stand on patient’s right.
• Start in RIF → RUQ, moving up with inspiration.
• Feel for the liver edge:
  • Smooth, soft: normal or CCF.
  • Firm, irregular: cirrhosis, tumour.
  • Tender: hepatitis, abscess, congestion.
  • Pulsatile: tricuspid regurgitation 💓.
• Comment on cm below costal margin, texture, tenderness.

📏 Percussion

• Liver span: Percuss MCL from chest → dullness (upper border), and from RIF upward → dullness (lower border). Normal = 6–12 cm.
• Helps distinguish hepatomegaly from RCF hyperinflation or ascites.

🎧 Auscultation

• Listen over liver for:
  • Bruit: vascular lesions, HCC.
  • Friction rub: perihepatitis (e.g., Fitz-Hugh-Curtis).

📊 Common Findings & Interpretation

📝 Documentation

• Record:
  • Size: cm below costal margin + span.
  • Edge: texture, tenderness, pulsatility.
  • Associated signs: ascites, jaundice, stigmata.

📚 Patient Education

• Explain findings in simple language: e.g. “Your liver feels a little enlarged, which can have many causes.”
• Discuss further tests: LFTs, ultrasound, viral hepatitis screen, CT/MRI if suspicious mass.
• Safety-net advice: return if jaundice, bleeding, confusion.

✅ OSCE Key Points

• Start in RIF and work up with inspiration. • Quote cm below costal margin and span. • Always describe edge feel + tenderness. • Don’t forget to listen for bruits/rubs. • Close by saying you’d complete with: spleen exam, renal exam, urine dip, DRE.