Liver mass physical examination: Difference between revisions

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__NOTOC__
__NOTOC__
{{Liver mass}}
{{Liver mass}}
{{CMG}}{{AE}}{{MV}}
{{CMG}} ; {{AE}} {{MV}} {{ADG}}


==Overview==
==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 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: [[janudice]], [[hepatomegaly]], abdominal [[tenderness]], [[splenomegaly]], abdominal wall vascular collaterals, and [[weight loss]].


==Physical Examination==
==Physical Examination==
*The following physical examination findings may be present among patients with liver mass:
The following physical examination findings may be present among patients with liver mass:<ref name="pmid22541698">{{cite journal |vauthors=Bonder A, Afdhal N |title=Evaluation of liver lesions |journal=Clin Liver Dis |volume=16 |issue=2 |pages=271–83 |year=2012 |pmid=22541698 |doi=10.1016/j.cld.2012.03.001 |url=}}</ref><ref name="pmid15062656">{{cite journal |vauthors=Gibbs JF, Litwin AM, Kahlenberg MS |title=Contemporary management of benign liver tumors |journal=Surg. Clin. North Am. |volume=84 |issue=2 |pages=463–80 |year=2004 |pmid=15062656 |doi=10.1016/j.suc.2003.11.003 |url=}}</ref><ref name="pmid9361515">{{cite journal |vauthors=Weimann A, Ringe B, Klempnauer J, Lamesch P, Gratz KF, Prokop M, Maschek H, Tusch G, Pichlmayr R |title=Benign liver tumors: differential diagnosis and indications for surgery |journal=World J Surg |volume=21 |issue=9 |pages=983–90; discussion 990–1 |year=1997 |pmid=9361515 |doi= |url=}}</ref><ref name="pmid15815209">{{cite journal |vauthors=Choi BY, Nguyen MH |title=The diagnosis and management of benign hepatic tumors |journal=J. Clin. Gastroenterol. |volume=39 |issue=5 |pages=401–12 |year=2005 |pmid=15815209 |doi= |url=}}</ref><ref name="pmid11240457">{{cite journal |vauthors=Cherqui D |title=[Benign liver tumors] |language=French |journal=J Chir (Paris) |volume=138 |issue=1 |pages=19–26 |year=2001 |pmid=11240457 |doi= |url=}}</ref><ref name="pmid12122868">{{cite journal |vauthors=Wanless IR |title=Benign liver tumors |journal=Clin Liver Dis |volume=6 |issue=2 |pages=513–26, ix |year=2002 |pmid=12122868 |doi= |url=}}</ref><ref name="pmid7740799">{{cite journal |vauthors=Nagorney DM |title=Benign hepatic tumors: focal nodular hyperplasia and hepatocellular adenoma |journal=World J Surg |volume=19 |issue=1 |pages=13–8 |year=1995 |pmid=7740799 |doi= |url=}}</ref>


===General appearance===
===General appearance===
*Well-appearing
*Patients could be well appeared. However, some of them, based on the etiology and stage might be:
*[[Lethargic]]
**[[Lethargic]]
*[[Cachectic]]
**[[Cachexia|Cachectic]]
*Confused
**Confused


===Vital Signs===
===Vital Signs===
* High-grade or low grade [[fever]]
* [[Tachycardia]]
* [[Tachypnea]]
* Decreased SPO2
* Decreased SPO2
* [[Tachypnea]]
* [[Tachycardia]]
* [[High-grade fever]]
* [[Low-grade fever]]


===Chest===
===Chest===
'''Inspection'''
'''Inspection'''
*Chest alopecia  
*Chest [[alopecia]]
*Rapid rate of breathing
*Rapid rate of breathing
'''Auscultation'''  
'''Auscultation'''  
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'''Inspection'''
'''Inspection'''
*Caput medusae
*Caput medusae
:* Appearance of distended and engorged superficial epigastric veins
** Appearance of distended and engorged superficial epigastric veins
'''Auscultation'''  
'''Auscultation'''  
*''Cruveilhier-Baumgarten murmur''
*Perform the liver scratch test
:* Described as a venous hum in patients with portal hypertension
**Useful for liver size determination
:* Present in patients with cirrhosis
*Cruveilhier-Baumgarten murmur
** Described as a venous hum in patients with [[portal hypertension]]
** Present in patients with [[cirrhosis]]
'''Percussion'''
'''Percussion'''
*Dull percussion
*Dull percussion
'''Palpation'''
'''Palpation'''
*Abdominal distention
*[[Abdominal distension|Abdominal distention]]
*[[Tenderness]] in right upper quadrant 
*[[Hepatomegaly]]
*[[Hepatomegaly]]
*[[Splenomegaly]]
*[[Splenomegaly]]
===Musculoskeletal===
===Musculoskeletal===
* Peripheral edema
* [[Pedal edema|Peripheral edema]]
* Muscle rigidity
* Muscle rigidity
* Hypertrophic osteoarthropathy
* [[Hypertrophic osteoarthropathy]]


===Skin===
===Skin===
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*[[Jaundice]]
*[[Jaundice]]
* Plantar and [[palmar erythema]]
* Plantar and [[palmar erythema]]
* Dermatographic urticaria, or "scratching marks"
* Dermatographic [[urticaria]], or "scratching marks"
* Nail changes
* Nail changes
:*Muehrcke nails  
:*Muehrcke nails  
:*Terry nails, or "luekonychia"
:*Terry nails, or "[[leukonychia]]"
 
===HEENT===
===HEENT===
*[[Lymphadenopathy]]
*[[Lymphadenopathy]]


===CNS===
===CNS===
*[[Confusion]]  
*[[Confusion]]  
*[[Asterixis]]
*[[Asterixis]]
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*[[Weakness]]
*[[Weakness]]
* Absent [[pulse]]
* Absent [[pulse]]
==Gallery==
<div align="left">
<gallery heights="175" widths="175">
Image:PHIL 2860 lores.jpg| '''Jaundice'''
Image:Hepaticfailure.jpg|'''Portal hypertension in hepatocellular carincoma''': This image shows the abdomen of a person with cirrhosis showing massive fluid buildup and visible veins
</gallery>
</div>
==References==
==References==
{{reflist|2}}
{{Reflist|2}}
 
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[[Category:Disease]]
[[Category:Medicine]]
[[Category:Types of cancer]]
[[Category:Gastroenterology]]
[[Category:Hepatology]]
[[Category:Oncology]]
[[Category:Oncology]]
[[Category:Up-To-Date]]
[[Category:Surgery]]

Latest revision as of 22:32, 29 July 2020

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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

Chest

Inspection

Auscultation

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

Percussion

  • Dull percussion

Palpation

Musculoskeletal

Skin

Inspection

HEENT

CNS

Extremities

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ Choi BY, Nguyen MH (2005). "The diagnosis and management of benign hepatic tumors". J. Clin. Gastroenterol. 39 (5): 401–12. PMID 15815209.
  5. ↑ Cherqui D (2001). "[Benign liver tumors]". J Chir (Paris) (in French). 138 (1): 19–26. PMID 11240457.
  6. ↑ Wanless IR (2002). "Benign liver tumors". Clin Liver Dis. 6 (2): 513–26, ix. PMID 12122868.
  7. ↑ Nagorney DM (1995). "Benign hepatic tumors: focal nodular hyperplasia and hepatocellular adenoma". World J Surg. 19 (1): 13–8. PMID 7740799.
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