angle tenderness. Next thing I want to do
is feel out for the liver. How do we do that?
Ask them to breath in and as they breath in,
you’d put your fingers through and it will
tap against them. Perfect! So I’m just going
to let the patient
know. I’m just going to see if I can feel
the side of your kidney, and I’m going to
start here, just above your hip, okay. What
I’d like you to do is take some deep breath
in and out. Breathe in, good, and breathe out.
Again, breathe in and out. Essentially, what
you’re doing is pushing in as the
patient breath in, and you’re trying to
catch that liver edge as it goes past. Okay.
You do the same for this spleen, where would
you start? Same place, yeah. Remember, if you
can feel any enlarged spleen,
it’s an enlarged spleen. It has to be about
three times the size which we’d be able
to palpate it. So again, you start from here.
You’re getting the patient to take breathe
in and out and go all the way across. If it
was a woman and she was potentially gravid,
you may also feel for a uterus as well, and
you can also palpate for the body. Okay.
But I won’t do that because you might want to
rush in the bathroom. What would you do after palpation?
Yeah, absolutely. I’m going to just have
a quick tap on you, Tommy, if that’s alright?
So again, I’m looking at his face
and I’m going to systematically, across
all nine quadrants. What is this useful for?
Yeah, ascites. So it’s checking to see if
there’s any fluid. What would you hear if
it was fluid?
Absolutely. So it’s quite an important sign
that you need to elicit as well. So, what
would you do in that case if you just saw
any abdominal distension that you wanted to
see if there was any fluid there? You’d
start from the centre and percuss out.
And then if you got to the point where your resonant
percussion note became a dull percussion note,
keep your finger on there and you’d ask
the patient to roll over to the side.
So, can I get you to roll over to the side? Please
don’t fall off the couch. Great! Keeping
your finger in the same place and you’d
say to them I’m going to keep you like this
for about 30 seconds. If I can demonstrate
that this dull percussion note has gone to
a resonant percussion note, then I’ve demonstrated
That’s fine. Can I get you to lay back?
We can also percuss out the borders of the
liver and the spleen as well. I’m going
to go onto auscultation. So just explain to