So, what I tend to do is, have you heard of
a scratch test, which I don’t know what
are you doing in your exams. Can I get you
to lie down again for me? I remember one of
my consultants teaching me this. You probably
don’t do this because you are really young.
But if you’ll imagine the train track and
someone is tapping on one side because that
transmission is going through the train track.
You can feel it further down. It’s the same
principle. So because all of this is air
got a rib overlying a relatively dense structure
like the liver, what you can do is if you
take your stethoscope, feel for the bottom
part of the rib and you put your stethoscope
on. If you kind of scratch up when you notice
that you can hear the scratching.
That’s the liver edge.
Yes, he did.
He still teaches that.
I think that’s the most useful thing that
I’ve done because I find it quite difficult
to palpate out livers. And if you’re tapping
for shifting dullness,
do you have to be parallel to the bed of your
finger going down? Because a lot are doing
it like that but is it the correct way to
do like that?
Say that again. So, why not --
Your finger, the one that you have on the
abdomen must be parallel to the counter base.
Because if I’m doing it that way, I’ll
give you an exam and I could say, “Well,
how do you know that it’s not the tip of
your phalanx rather than down here where you’re
feeling the percussion note?” So yeah, it
needs to be parallel. It’s fine. You can
get up again.
I think it was about the liver. See, you need
to be tapping out the borders, and how big should
the liver actually be?
You tell me, how big should it be.
Four fingerbreadths, about 10-12 cm. Above the costal margin.
Where does your liver start in your chest?
Yeah, it’s about your
sixth anterior but it’s around T4. So it
goes really -- Tell me why we have to tap
it out from the
top because if it’s a woman, it’s difficult
Again, it’s different to what you do in
clinical practice, but ideally yeah you’re supposed
to tap it out and I always start on the chest,
go down. It’s unlikely you’re going to
get woman for an abdo exam if it’s something
that you need to percuss out anyway. So if
you percuss it down you’ll go from resonant
resonant resonant because you’re going lung,
lung, lung. Then when you get to liver, you’ll
notice the percussion note changes.
Spleen has to be three times its normal size
to be palpable. The liver even in thin persons,
can you feel it and know pathology? Someone
told me that even in thin persons you'll never
feel the liver unless there’s something wrong,
but I seem to find that you can feel it --
I’ve felt it in people that are
otherwise well. Okay. Thank you.