Upper and lower liver percussion

The upper and lower hepatic percussion is an examination method that makes a moderate attack on the normal position of the liver and makes a preliminary judgment on whether there is a voiced or unvoiced sound. It is generally along the right clavicle midline, the right medial midline and the right scapula line, which is swollen from the lung area to the abdomen. Use your fingers to be appropriate, not too light or too heavy. When it is changed from unvoiced to voiced, it is the upper limit of the liver. Basic Information Specialist classification: Digestive examination classification: other examinations Applicable gender: whether men and women apply fasting: not fasting Tips: Pay attention to normal eating habits and pay attention to personal hygiene. Normal value The liver of the upper and lower boundary of the normal liver is in the midline of the right clavicle, the upper boundary is the fifth intercostal space, and the lower boundary is located at the lower edge of the right rib. The distance between the two is the hepatic upper and lower diameter, about 9 to 11 cm; On the midline, the upper boundary is the 7th intercostal space, the lower boundary is equivalent to the 10th rib level; on the right shoulder line, the upper boundary is the 10th intercostal space. In the short fat body, the upper and lower boundaries of the liver can be higher than one rib, and the elongated body can be lower than the rib. Clinical significance Abnormal results There are several changes in the upper and lower limits of the liver. 1) The expansion of liver dullness is seen in liver cancer, liver abscess, hepatitis, hepatic congestion and polycystic liver disease. 2) The narrowing of the liver dullness is seen in fulminant hepatitis, acute liver necrosis, cirrhosis and flatulence. 3) The disappearance of liver dullness is replaced by drum sounds, which are caused by gas on the surface of the liver. It is an important sign of acute gastrointestinal perforation, but it can also be seen within a few days after major abdominal surgery, after artificial pneumoperitoneum. The colon (the colon is located between the liver and the diaphragm), the internal visceral transposition, and the like. 4) The upward shift of the dullness of the liver is seen in the right pulmonary fibrosis, the right lower lung atelectasis, and the pneumoperitoneum. 5) The downward shift of the liver dullness is seen in emphysema and right-sided tension pneumothorax. People who need to be examined: patients with the above suspected symptoms Precautions Forbidden before examination: Pay attention to normal eating habits and pay attention to personal hygiene. Requirements for inspection: Actively cooperate with the doctor. Inspection process Percussion method 1) Determine the upper boundary of the liver: generally along the midline of the right clavicle, the midline of the right iliac crest and the right scapula line, from the lung area down to the abdomen. Use your fingers to be appropriate, not too light or too heavy. When it is changed from unvoiced to voiced, it is the upper limit of the liver. This is equivalent to the top of the liver covered by the lungs, so it is also called the liver relative to the voiced boundary. Then squat down between 1 and 2 intercostals, the voiced sound becomes a real sound, and the liver here is no longer covered by the lungs and directly close to the chest wall, which is called the absolute dullness of the liver (also the lower lung boundary). 2) Determining the lower hepatic boundary: Generally, the abdominal drum sound region is squatting along the midline or midline of the right clavicle, and the lower part of the liver is turned from the drum sound to the voiced sound. However, because the lower hepatic border overlaps with the stomach and colon, it is difficult to determine the standard. Therefore, it is more common to use palpation and percussion to determine that the lower hepatic margin of the Chad is 1 to 2 cm higher than the lower edge of the liver, but if the liver is obvious Thickening, the two results are closer. Not suitable for the crowd Inappropriate crowd: no Adverse reactions and risks Nothing.