Pre PACES Podcast #67 Chronic liver disease (part 1)
16 snips
Aug 13, 2023 Dr Phil Berry, consultant hepatologist at Guy's & St Thomas' and PACES author, guides listeners through chronic liver disease. He describes bedside inspection clues, hand and skin signs, abdominal assessment for ascites and organomegaly. Short practical tips on presentation structure, distinguishing compensated vs decompensated disease, and clues to underlying causes are highlighted.
AI Snips
Chapters
Transcript
Episode notes
Palpation Technique For Hepatomegaly
- Use a methodical palpation: light then deep in four quadrants, then search for liver edge from the right iliac fossa upwards.
- Believe what your hands feel and characterise edge size, smoothness and tenderness, then percuss to confirm span.
Spleen And Ascites Maneuvers
- For the spleen, palpate diagonally from the right lower quadrant to the left and ask the patient to roll onto their right side.
- Use shifting dullness to confirm ascites and demonstrate you can test for fluid clinically.
Auscultation And Cardiac Considerations
- Auscultate over the liver if you suspect a vascular tumour but otherwise focus examination on relevant targets.
- If you suspect right heart failure, mention checking JVP and testing for a pulsatile liver or hepatojugular reflex.