ABNORMARLITIES ON PHYSICAL

EXAMINATION IN A PATIENT
WITH HEPATOSPLENOMEGALY
Inspection
Palpation

In palpation of liver , look for :

I. Extent of liver enlargement
II. Surface : smooth or nodular
III. Edge : round or sharp
IV. Consistency : soft, firm or hard
V. Tenderness
Palpation

• In palpation of spleen, look for :

I. Size
II. Consistency
III. Edge
IV. Tenderness

• In massive splenomegaly, spleen is

palpable >8cm below costal margin
 DIFFERENTIATING A PALPABLE
SPLEEN FROM LEFT KIDNEY
FEATURES SPLEEN KIDNEY
Smooth mass & regular More likely PKD are bilateral irregular
shape masses
Mass descends in Yes. Superficially & Yes. Moves deeply &
inspiration diagonally vertically
Able to feel deep in the Yes No
mass
Palpable notch in medial Yes No
surface
Bilateral masses palpable No Sometimes

Percussion resonant to No Sometimes

the mass
Mass extends beyond the Sometimes No (except with
midline horseshoe kidney)
 PERCUSSION
• Upper border (start from Rt
2nd intercostal space in
MCL till dullness) & lower
border (start from Rt iliac
fossa towards the costal
margin )
• In massive hepatomegaly :
>10 cm below costal
margin