Clinical examination of the liver and biliary system
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Examination of the liver
1. The normal liver, the laegest organ in the body, weighs about 1.5kg . The upper border is at the level of the 5th rib, the lower border lies under the costal margin on the right. The lower edge is usually palpable in deep inspiration when the live moves downwards. The upper border is defined by heavy percussion. Light percussion together with palpation will identify the lower border. An estimate of liver size can be obtained from the verticallength of dullness to percussion in the right mid clavicular line (usually 12-15cm). It is reduced in cirrhosis and fulminat hepatitis and is important in monitoring progress. Routine examination of the liver must include auscultation for friction rubs. These may be due to a recent liver biopsy or to a tumour. Arterial bruits may be related to acute alcoholic hepatitis or to primary liver cell cancer. Venous hums can be due to portal hypertension. The spleen is rarely palpable in health.
2. Isotope scan of the liver. An intravenous injection of the gamma emitting isotope tech-netium is taken up by the reticulo-endothelial cels of the liver. The normal scan shows a uniform distribution of the isotope throughout the liver; no isotope uptake is seen in the spleen. Filling defects larger than about 2cm will be shown. In special circumstances other isotopes are employed. Gallium citrate is taken up by primary liver cel cancers and granulocytes in the walls of abscesses. These lesions give filling defects with a technetium scan.
1. The normal liver, the laegest organ in the body, weighs about 1.5kg . The upper border is at the level of the 5th rib, the lower border lies under the costal margin on the right. The lower edge is usually palpable in deep inspiration when the live moves downwards. The upper border is defined by heavy percussion. Light percussion together with palpation will identify the lower border. An estimate of liver size can be obtained from the verticallength of dullness to percussion in the right mid clavicular line (usually 12-15cm). It is reduced in cirrhosis and fulminat hepatitis and is important in monitoring progress. Routine examination of the liver must include auscultation for friction rubs. These may be due to a recent liver biopsy or to a tumour. Arterial bruits may be related to acute alcoholic hepatitis or to primary liver cell cancer. Venous hums can be due to portal hypertension. The spleen is rarely palpable in health.
2. Isotope scan of the liver. An intravenous injection of the gamma emitting isotope tech-netium is taken up by the reticulo-endothelial cels of the liver. The normal scan shows a uniform distribution of the isotope throughout the liver; no isotope uptake is seen in the spleen. Filling defects larger than about 2cm will be shown. In special circumstances other isotopes are employed. Gallium citrate is taken up by primary liver cel cancers and granulocytes in the walls of abscesses. These lesions give filling defects with a technetium scan.
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