Back to ascites, shifting dullness,
is it alright to do that or do you have to
do the fluid thrill thing as well?
You can do the fluid thrill. Shall we? Do you want to
I can’t remember how to do that.
Okay. So, what I’m going to ask you to do
is I’m just going to have to tap on your
tummy. But if I can borrow your hand, just
get you to place that across your tummy, what
I’m going to do is I’m going to flick
on one side of your tummy and I’m going
to put a hand on the other side. So, what
am I doing? That’s fine.
You can get the patients to do that.
Exactly. Sit up for me. So, what you’re
doing is essentially when you’re tapping one
side, you are just stopping any skin conduction
by putting that hand there and you’re checking
to see whether or not that pulse is being
transmitted through the underlying fluid.
But again, take it in the context. If someone
has obviously got ascites, that somebody has
got a massive amount of tense ascites.
So you might have a small ascites that you might
necessarily be able to demonstrate a fluid
thrill on, but you might be able to demonstrate
shifting dullness on.
I have a quick question about hepatomegaly.
I’ve read different things in different
books. Some people would say that it’s better
to feel in for the liver when they’re breathe
in. Yeah. And then some people say
that when you
breathe out, your lungs fill with air so they
push the liver down. So, that means you should
do it when they breathe out because then you’ll
feel the liver hitting your hand. So I wasn’t
too sure which one –
When you breathe in your lungs fill with air.
Oh yeah. But I’ve read two different things
in the book.
No. I can see why you’re confused. I thought
you want to be in there when they
take a breath. As they’re taking a breath
in and you’re
pushing in and you’re supposed to be putting
your hand a third down so you can feel that
long-edge passing as they’re taking a breath
in. Does that make sense?
So not when they’re breathing out?
When they’re breathing out, that liver is
just moving about. So you might potentially
catch the edge of it but it’s much easy
to feel something going in that direction.
Yeah, breathing in pushes it down. Okay.
That’s fine. I think you meant like in
the book, like you push in
and keep your hands still while they
breathe out and then you might feel it hitting
your hand. Yeah. Maybe that’s probably it.
for them to breathe out and then leave
And then when they breathe in, yeah. But you’re
trying to like meet it.
In clinical practice, I don’t really do
that because I don’t find it very accurate.
So, what I tend to do is, have you heard of
a scratch test, which I don’t know what