Liver mass physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2] Aditya Ganti M.B.B.S. [3]
Overview
Physical examination findings of liver mass will depend on location and size of the tumor. Usually large liver tumors may cause pain and tenderness in palpation of the abdomen due to stretching of the liver capsule. On the other hand, liver masses with smaller size can present with no remarkable findings. Common physical examination of patients with liver mass, may include jaundice, hepatomegaly, abdominal tenderness, splenomegaly, abdominal wall vascular collaterals, and weight loss.
Physical Examination
The following physical examination findings may be present among patients with liver mass:[1][2][3][4][5][6][7]
General appearance
- Patients could be well appeared. However, some of them, based on the etiology and stage might be:
Vital Signs
- High-grade or low grade fever
- Tachycardia
- Tachypnea
- Decreased SPO2
Chest
Inspection
- Chest alopecia
- Rapid rate of breathing
Auscultation
- Decreased/absent breath sounds
Percussion
- Dull percussion
- Reduced chest expansion
Abdomen
Inspection
- Caput medusae
- Appearance of distended and engorged superficial epigastric veins
Auscultation
- Perform the liver scratch test
- Useful for liver size determination
- Cruveilhier-Baumgarten murmur
- Described as a venous hum in patients with portal hypertension
- Present in patients with cirrhosis
Percussion
- Dull percussion
Palpation
- Abdominal distention
- Tenderness in right upper quadrant
- Hepatomegaly
- Splenomegaly
Musculoskeletal
- Peripheral edema
- Muscle rigidity
- Hypertrophic osteoarthropathy
Skin
Inspection
- Pallor
- Jaundice
- Plantar and palmar erythema
- Dermatographic urticaria, or "scratching marks"
- Nail changes
- Muehrcke nails
- Terry nails, or "leukonychia"
HEENT
CNS
Extremities
References
- ↑ Bonder A, Afdhal N (2012). "Evaluation of liver lesions". Clin Liver Dis. 16 (2): 271–83. doi:10.1016/j.cld.2012.03.001. PMID 22541698.
- ↑ Gibbs JF, Litwin AM, Kahlenberg MS (2004). "Contemporary management of benign liver tumors". Surg. Clin. North Am. 84 (2): 463–80. doi:10.1016/j.suc.2003.11.003. PMID 15062656.
- ↑ Weimann A, Ringe B, Klempnauer J, Lamesch P, Gratz KF, Prokop M, Maschek H, Tusch G, Pichlmayr R (1997). "Benign liver tumors: differential diagnosis and indications for surgery". World J Surg. 21 (9): 983–90, discussion 990–1. PMID 9361515.
- ↑ Choi BY, Nguyen MH (2005). "The diagnosis and management of benign hepatic tumors". J. Clin. Gastroenterol. 39 (5): 401–12. PMID 15815209.
- ↑ Cherqui D (2001). "[Benign liver tumors]". J Chir (Paris) (in French). 138 (1): 19–26. PMID 11240457.
- ↑ Wanless IR (2002). "Benign liver tumors". Clin Liver Dis. 6 (2): 513–26, ix. PMID 12122868.
- ↑ Nagorney DM (1995). "Benign hepatic tumors: focal nodular hyperplasia and hepatocellular adenoma". World J Surg. 19 (1): 13–8. PMID 7740799.