You are examining a 55-year-old female patient with a history of alcohol abuse. She complains of anorexia, nausea, pruritus, and weight loss over the last month. On physical examination, you note yellow hue of the skin and sclera
Which of the following physical examination techniques is most important?
A. Scratch test
B. Heel strike
C. Digital rectal examination
D. Pelvic examination
ANS: A
Cirrhosis develops with the replacement of normal liver tissue by regenerative, fibrotic nodules and may occur in the late phase of a variety of disorders that damage the liver, such as alcohol toxicity. A patient may present with jaundice and describe an associated, progressive pattern of pruritus, weakness, anorexia, nausea, and weight loss. Determine the size and consistency of the liver as well as any tenderness. The scratch test is a method used to ascertain the location and size of a patient's liver during a physical assessment. The scratch test uses auscultation to detect the differences in sound transmission through the abdominal cavity over solid and hollow organs and spaces. After placing a stethoscope over the approximate location of a patient's liver, the examiner will then scratch the skin of the patient's abdomen lightly, moving laterally along the liver border. When the liver is encountered, the scratching sound heard in the stethoscope will increase significantly. In this manner, the size and shape of a patient's liver can be ascertained.
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