Liver Enlargement (Hepatomegaly): Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; further:
    • Inspection (viewing).
      • Skin, mucous membranes and sclerae (white part of the eye).
      • Abdomen (abdomen):
        • Shape of the abdomen?
        • Skin color? Skin texture?
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels?
        • Scars? Hernias (fractures)?
    • Auscultation (listening) of the heart [right heart failure (right heart weakness)].
    • Examination of the abdomen
      • Percussion (tapping) of the abdomen
        • [Ascites (abdominal fluid): phenomenon of fluctuation wave. This can be triggered as follows: if one taps against one flank a wave of fluid is transmitted to the other flank, which can be felt by placing the hand on it (undulation phenomenon); flank attenuation.
        • Meteorism (flatulence): hypersonoric tapping sound.
        • Attenuation of the tapping sound due to enlarged liver or spleen, tumor, urinary retention?
        • Hepatomegaly (liver enlargement) and/or splenomegaly (spleen enlargement): estimate liver and spleen size]
      • Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, guarding tension?, hernial orifices?, renal bearing knocking pain?) [fatty liver (steatosis hepatis); hepatitis (liver inflammation); pancreatic (pancreas) tumor, unspecified]
    • Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation: assessment of the prostate in size, shape and consistency.
  • Orthopedic/rheumatologic examination [due todifferential diagnoses:
    • Chronic polyarthritis
    • Felty syndrome – special form of rheumatoid arthritis that occurs mainly in men.
    • Collagenoses (group of connective tissue diseases caused by autoimmune processes) – systemic lupus erythematosus (SLE), polymyositis (PM) or dermatomyositis (DM), Sjögren’s syndrome (Sj), scleroderma (SSc) and Sharp syndrome (“mixed connective tissue disease”, MCTD).
    • Still syndrome (synonym: Still’s disease): systemic form of juvenile rheumatoid arthritis occurring in children with hepatosplenomegaly (liver and spleen enlargement), fever (≥ 39 °C, over 14 days), generalized lymphadenopathy (lymph node enlargement), carditis (inflammation of the heart), transient exanthema (skin rash), anemia (anemia). The prognosis of this disease is unfavorable].
  • Urological examination [due todifferential diagnosis: unexplained renal enlargement, unspecified].

Square brackets [ ] indicate possible pathological (pathological) physical findings.