Objective Data- Percuss Liver Span Measure the distance between the two marks Normal liver span (adult) 6-12cm taller persons have longer livers Men > women Hepatomegaly: liver enlargement (inflammation/infection of liver; liver congestion (CHF) Difficult to assess when have lung disease or abdominal pathology since resonance or tympany will be affected

Objective Data- Percussion Percuss for Splenic Dullness Percuss for dullness from the 9th to 11th intercostal space just behind midaxillary line (Traube’s space) Normally, the area of splenic dullnes is not wider than 7cm and should not be anterior of the midaxillary line; tympany should prevail Dullness anterior of the midaxillary line indicates Splenomegaly

Objective Data- Percussion Percuss for Costovertebral Angle Tenderness (CVAT) to assess the kidneys Place one hand over the 12th rib (posteriorally) at the costovertebral angle Thump hand with fist Normally, no tenderness +CVAT with inflammation or infection of kidney

Objective Data- Palpation Perform PALPATION to judge the size, location, and consistency of certain organs and to assess for masses or tenderness Make patient comfortable first! (knees bent, slow breathing) Look at the patient’s face for any signs of pain Begin with LIGHT palpation With first four fingers, depress the skin about 1cm Make a gentle rotary motion, moving clockwise to next location around abdomen (slide fingers and skin together, then lift fingers and move)

Objective Data- Palpation Light palpation enables you to form an overall impression of the skin and muscles Save the examination of tender areas for last Assess for voluntary versus involuntary muscle guarding Voluntary guarding: due to coldness, tense, ticklish- can be decreased with warmth or relaxation Involuntary guarding: constant board-like hardness of muscles due to acute inflammation of the peritoneum

Objective Data- Palpation Next, perform DEEP palpation Four fingers, pushing down 5-8cm, moving clockwise around the abdomen, saving tender areas for last Can use one hand or two hand (on top of each other) Note: location, size, consistency, and mobility of any palpable organs Note: presence of abdominal enlargement, tenderness, or masses If present, describe (location, size, shape, consistency, mobility, pulsatility, tenderness)

Objective Data- Palpation Palpate the LIVER Left hand under patient’s back, right hand on the RUQ, fingers parallel to midline Push deeply down and under right costal margin Ask patient to breath slowly, moving your hand up 1 or 2cm with each exhalation Normal: to feel edge of liver bump your fingertips as the diaphragm pushes it down during inhalation (firm, regular ridge) OR non-palpable liver edge Abnormal: liver palpable >1-2cm below the right costal margin

Objective Data- Palpation Alternate method for palpating the liver is the HOOKING technique Stand at patient’s shoulder and face patient’s feet Hook fingers over the costal margins form above Patient to take a deep breath Feel for the liver edge to bump your fingertips during inhalation

Objective Data- Palpation Palpate the SPLEEN Normally, spleen is not palpable (has to be enlarged 3x in order to feel it) Reach your left hand over the abdomen and behind the left side of the 11th and 12th ribs Place right hand on LUQ with fingers pointing toward left axilla, just inferior to rib margin Push your hands deeply down and under left costal margin and ask patient to take a deep breath Normal: non-palpable spleen Abnormally enlarged: mononucleosis, trauma, leukemia, lymphomas, malaria If enlarged, describe how many centimeters below the left costal margin

Objective Data- Palpation Palpate the right kidney Place your hands together in a “duck-bill” position at the patient’s right flank Use deep palpation and ask patient to take a deep breath; try to capture the kidney between both hands Normal: no palpation of kidney OR you may feel the lower pole of the right kidney as a round, smooth, mass slide between your fingers Abnormal: enlarged, irregular mass, tender Palpate the Left Kidney Sits 1cm higher than the right kidney and is not palpable normally Reach left hand across abdomen and behind flank Push right hand deep into abdomen and ask patient to deep breath; try to capture the kidney between your hands OR, move to left side of bed and do same technique as right

Objective Data- Palpation Palpate the aortic pulsations Use opposing thumb and fingers or two hands with fingers directed toward each other, palpate DEEP in superior to the umbilicus Normally: 2.5-4cm wide in adult and pulsates in an anterior direction Abnormal: widened and lateral pulsations with aneurysm Changed….