1. 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

2. 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

3. 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

4. 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)

5. 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

6. 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)

8. 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

10. 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

11. 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

14. 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

17. 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
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