Focused Liver Exam
Focused Liver Exam
Please assess the student performing a focused liver exam.
Student's Email:

GENERAL - Observe the student doing the following:

Washes hands
       
Introduces self and exam to patient
           
Appropriate draping of patient

Expose from the nipple line to the ASIS

               

INSPECTION - The student should comment on the following:

Patient's general appearance

Ex: writhing, still, cachectic, generally well/unwell etc.

               
Nail changes

Ex: Clubbing, leukonychia or Terry's nails

               
Hand changes

Ex: Palmar erythema, Dupuytren's contracture, thenar wasting

               
Asterixis
               
Temporal muscle wasting
               
Scleral icterus
               
Fetor hepaticus
               
Gynecomastia
               
Spider angiomas or telangiectasias
               
Caput Medusae
               
Ascites

Best observed from the foot of the bed (bulging flanks)

               
Testicular atrophy
               
Peripheral edema
               

PERCUSSION - Observe the student performing the following manoeuvers:

Measures liver span & comments on expected findings

Percuss down from clavicle and up from RLQ along the midclavicular line

               

PALPATION - Observe the student performing the following manoeuvers:

Palpate liver edge & comment on expected findings

Palpate up from RLQ for liver enlargement

               

AUSCULTATION - Observe the student performing the following manoeuvers:

Auscultates for hepatic bruits
               

SPECIAL TESTS - Observe the student performing the following manoeuvers:

Tests for ascites

Shifting dullness and fluid wave test

               
Attempts to elicit Murphy's sign

Abrupt interruption of inspiration upon palpation over gallbladder

               

GLOBAL RATING SCALES - Please rate the student on their overall performance:

Understands rational of manoeuvers and findings
                   
Organized approach
                   
Sensitivity toward patient concerns and comfort during the examination