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
| Liver Edge | Description | Likely Cause |
|---|
| 🟢 Smooth, soft, non-tender | Just palpable, normal | Normal or mild enlargement |
| 🔵 Smooth, firm | Non-tender, enlarged | Cirrhosis, lymphoma |
| 🟡 Smooth, tender | Edge descends with pain | Hepatitis, CCF, alcoholic liver disease |
| 🔴 Hard, irregular | Lumpy, nodular | HCC, metastases |
| 💓 Pulsatile | Expansile with heartbeat | Tricuspid regurgitation |
📝 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.
