Question

A 63‐year‐old janitor with a history of adenomatous colonic polyps presents for a well visit. Basic labs are performed to screen for diabetes mellitus and dyslipidemia. Electrolytes and liver enzymes were also measured. His labs are all normal expect for moderate elevations of aspartate aminotransferase, alanine aminotransferase, γ‐glutamyl transferase, and alkaline phosphatase as well as a mildly elevated total bilirubin. He presents for a follow‐up appointment and the clinician performs an abdominal exam to assess his liver. Which of the following findings would be most consistent with hepatomegaly?
a) Liver span of 11 cm at the midclavicular line
b) Liver palpable 3 cm below the right costal margin, mid clavicular line, on expiration
c) Dullness to percussion over a span of 11 cm at the midclavicular line
d) Dullness to percussion over a span of 8 cm at the midsternal line
e) Liver span of 8 cm at the midsternal line

Answer 1

Answer:

your anwser would be B

Explanation:

The liver being palpable 3 cm below the right costal margin,

midclavicular line, would be considered normal on inspiration when the

liver is pushed down into the abdominal cavity on inspiration, but is

abnormal on expiration. Findings to support hepatomegaly would be

more convincing if, by percussion, the liver span was >12 cm at the

midclavicular line. For patients with obstructive lung disease, air

trapping in the lungs may displace the liver downwards into the

abdominal cavity. The liver span and dullness to percussion refer to the

same measurement. Measurements of 6-12 cm at the mid‐clavicular line

and 4-8 cm at the midsternal line are considered normal.