View source for Examination of the gallbladder and liver

==Positioning==
*expose from nipples to pubis
*have patient lying supine on bed with knees flexed

==INSPECTION==
(from foot of the bed)
*level of comfort, jaundice
*abdominal distension, bulging flanks, visible abdominal mass
*prominent veins (caput medusae)

==PALPATION==
*patient relaxed and breathing slowly
*LIGHT palpation over entire abdomen, save tender areas to last
*DEEP palpation with finger tips, feel with inspiration, relocate during expiration

===LIVER===
*start in RLQ with the examining hand parallel to the rectus muscles, advance hand superiorly with expirations and anticipate the liver edge striking the forefinger on inspiration
*attempt to feel the surface of the liver
*describe: '''consistency, tenderness, nodularity, pulsations'''

===GALLBLADDER===
*orient hand perpendicular to the costal margin feeling from medial to lateral below the right costal margin (feels bulbous, focally rounded mass that moves downward on inspiration)

*'''Murphy’s sign (cholecystitis)'''
*place left hand with forefinger parallel to and at the RLCM and with thumb pressing on the intersection of the costal margin and the lateral border of the abdominal rectus muscle
**+ → pain elicited around the area pressed during a deep inspiration

==PERCUSSION==
*measure at the same point in the respiratory cycle

*LOWER BORDER: start below the umbilicus and percuss upward at right MCL and mid sternal line to liver dullness
*UPPER BORDER (6th ICS in MCL): from lung resonance and percuss downward to liver dullness 
*measure liver span (liver span is 10 at MCL, 6 at MSL)

==AUSCULTATION==
*hepatic friction rub (tumour, inflammation, infarct)
*venous hum (portal hypertension)
*bruit (HCC, acute ETOH hepatitis, AV malformation)

==Other OSCE modules==
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[[Acute Confusion (OSCE)|Acute Confusion]] -
[[Acute Coronary Syndrome Orders]] -
[[Anemia (OSCE)|Anemia]] -
[[Arterial Blood Gasses]] -
[[Asthma (OSCE)|Asthma]] -
[[Blood Pressure (OSCE)|Blood Pressure]] -
[[Chest pain]] -
[[Chest XRay (OSCE)|Chest XRay]] -
[[CHF Assessment (OSCE)|CHF]] -
[[Coma (OSCE)|Coma]] -
[[COPD Examination|COPD]] -
[[Cranial Nerve Exam (OSCE)|Cranial Nerves]] -
[[Diabetic History (OSCE)|Diabetic History]] -
[[Diabetic Foot Exam|Diabetic Foot]] -
[[Dysphagia Examination|Dysphagia]] -
[[EKG Analysis|EKGs]] -
[[Examination of the Gallbladder and Liver (OSCE)|Gallbladder and Liver]] - 
[[Extrahepatic Manifestations of Liver Disease (OSCE)|Liver Disease]] -
[[Gait and Balance (OSCE)|Gait and Balance]] -
[[Headache Assessment|Headache]] -
[[Hematemesis (OSCE)|Hematemesis]] -
[[Hypertension (OSCE)|Hypertension]] -
[[Jugular Venous Pulses]] - 
[[Knee Exam]] -
[[Lymph Node Exam (OSCE)|Lymph Nodes]] - 
[[Management Of Community Acquired Pneumonia|Community Acquired Pneumonia]] -
[[Parkinson disease (OSCE)|Parkinson Disease]] -
[[Chronic Peripheral Arterial Insufficiency|Peripheral Arterial Insufficiency]] -
[[Pneumonia Examination]] -
[[Precordial Exam (OSCE)|Precordial Exam]] -
[[Sexually Transmitted Diseases (OSCE)|STD's]] -
[[Spleen Exam (OSCE)|Spleen]] -
[[Swollen Leg Exam]] -
[[Thyroid Exam]] -
[[Upper vs Lower Motor Neuron Lesions]] -
[[Urinary Incontinence]]
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[[Category: Clinical Skills]][[Category:Gastroenterology]]
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