The Abdomen without notes 2018rev(1).pptx

43 palpation liver place left hand behind the patient

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PALPATION LIVER Place left hand behind the patient parallel to the 11 th rib on the right Remind pt to relax on right hand Place right hand on pt’s right side of abdomen lateral to the rectus muscle Press in and upwards on the stomach Ask pt to take a deep breath Try to feel liver’s edge when the pt exhales It should be felt on the fingertips, if palpable The normal liver may be slightly tender, soft liver edge, sharp, regular and smooth. 44
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ABNORMAL FINDINGS ON PALPATING THE LIVER Firmness or hardness of the liver Bluntness or rounding of its edge Irregularity of its contour Mass 45
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THE SPLEEN An Enlarged Spleen Expands: Anteriorly Downward Medially 46
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PALPATION OF THE SPLEEN Reach over and around the patient Press forward the lower left rib cage and adjacent soft tissue With your right hand below the left costal margin, press in toward the spleen. Begin palpation low enough so that you are below a possibly enlarged spleen. Ask the patient to take a deep breath. Try to feel the tip or edge of the spleen as it comes down to meet your fingertips. Note any tenderness, assess the splenic contour. 47
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THE KIDNEYS Retroperitoneal Usually not palpable 48
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PALPATION THE KIDNEYS Palpation of the Left Kidney Move to the patient’s left side. Place your right hand behind the patient, Lift, trying to displace the kidney anteriorly. Place your left hand gently in the left upper quadrant, lateral and parallel to the rectus muscle. Ask the patient to take a deep breath. At the peak of inspiration, press your left hand firmly and deeply into the left upper quadrant, just below the costal margin. Try to “capture” the kidney between your two hands. Ask the patient to breathe out and then to stop breathing briefly. Slowly release the pressure of your left hand, feeling at the same time for the kidney to slide back into its expiratory position. If the kidney is palpable, describe its size, contour, and any tenderness. 49
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PALPATION THE KIDNEY Palpation of the Right Kidney To capture the right kidney, return to the patient’s right side. Use your left hand to lift up from the back, Right hand to feel deep in the right upper quadrant. Proceed as before. A normal right kidney may be palpable, It may be slightly tender. The patient is usually aware of a capture and release. Occasionally, a right kidney is located more anteriorly and must be distinguished from the liver. The lower pole of the kidney is rounded. 50
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ABNORMAL KIDNEY FINDINGS Mass The edge extends beyond the midline, Your fingers can probe deep to the medial and lateral borders but not between the mass and the costal margin. Confirm findings with further evaluation. . 51
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PALPATION THE KIDNEY 52
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QUESTIONS 53
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