How does a clinician diagnose hepatomegaly

Condition analysis:
1. Palpation and percussion.
Evaluation of the liver is difficult given its irregular shape and its location within the abdomen. Approach palpation of the right upper quadrant from one of two directions: palpate from below using the fingertips to palpate superiorly or from above with the fingertips hooked over the lower rib. Either method is facilitated by the patient’s deep inspiration. Palpation must include the midline to identify an enlarged left lobe of the liver. On palpation, note the liver position, the extent of its palpation below the costal margin, and its texture and consistency. Palpate for the lower edge and percuss for the upper margin. These two points give the highest accuracy in estimating liver size. If the margin is not palpated but hepatomegaly is suspected, then attempt direct percussion of both margins.

2. Auscultation.
The "scratch method" (gently stroking or scratching the skin surface in a parallel plane while listening with the stethoscope for change in sound and intensity of frequency) has been used to identify margins; however, a recent study by Tucker comparing ultrasound to the results of the scratch test found that this test was unreliable and inaccurate . Auscultation of the right upper quadrant has been described and several findings can be noted: friction rubs, bruits, and abnormal pulsations.

3. Other associated signs.
Associated physical examination findings include jaundice, vascular spiders, palmar erythema, gynecomastia, ascites, splenomegaly, testicular atrophy, peripheral edema, Dupuytren’s contracture, parotid enlargement, and encephalopathy. Although none of these physical examination signs are pathognomonic for hepatobiliary disease, their presence in the setting of hepatomegaly support further diagnostic testing.

Instructions:
Homeopathic remedies
Nux vomica -- Indicated for enlarged livers due to alcohol abuse.

Carduus marianus -- Indicated for jaundice, headache, nausea, vomiting and a white tongue. Relieves gallstone colic.

Natrum Sulphuricum -- Dissolves gallstones and relieves hepatitis.

Ammonium muriaticum -- Used for pinching, shooting pains in the upper right abdomen.

Taraxacum -- Indicated for hardened livers, accompanied by jaundice, bilious diarrhea, and gastritis.

Chelidonium -- Indicated for an enlarged live, sharp stitching pains worse on the right side extending to the right shoulder blade.