Running Head: ASSESSING LIVER MARGINS

Assessing Liver Margins: The Scratch Test Dana L Knoll Ferris State University

ASSESSING LIVER MARGINS Assessing Liver Margins: The Scratch Test

Determining the size of the liver manually is an invaluable practice for assessing a patient. The size of the liver can often act as an indicator of the presence or absence of disease and disorder. Typically, the liver is palpated with the hands, either bimanual ventrodorsal or bimanual ventral. Palpation can become difficult if working with an abdomen that is tender, distended, or obese and something called the scratch test can be performed to determine the lower edge of the liver. Throughout the years the value of this technique has come into question but more recently Gupta et al (2013) reexamined the validity of the scratch test. The scratch test as described by Dillon has the provider place their stethoscope in the right upper quadrant above the liver. Once placed, the provider should take their finger and briskly stroke the abdomen, starting in the right lower quadrant and moving up toward the liver. The sound of the stroking finger should be transmitted to the stethoscope once it reaches the border of the liver (2007). Essentially the scratch test was performed the same way according to Gupta, et al, except that measures were taken to standardize the scratch test. Place the stethoscope on the xiphoid process and with one finger lightly stroke the abdomen transversely, (parallel to the expected livers edge) moving from the right lower quadrant to the costal margin. Instead of stopping at the first detection of increased sound, the stroke continued until the increased sound reached its maximum. This second point of maximum sound transmission is used as the best estimate of the edge of the liver (2013). Although Gupta, et al come to no solid conclusion as to whether the scratch test should be discontinued or not, they conclude that it requires further investigation. One promising aspect of the paper showed that standardizing the scratch test led to higher rates of reliability among different providers performing the test. Also, the paper supports using the point of maximum

ASSESSING LIVER MARGINS

sound as the estimated liver border instead of using the initial point of sound transmission (2013). It seems that the scratch test is a simple, noninvasive and cheap way to gain an initial assessment of possible disease/disorder regarding the liver. It is an invaluable tool that can be tweaked so that it is more precise and reliable.

References Dillon, P.M. (2007). Assessing the abdomen. Nursing Health Assessment: A Critical Thinking, Case Studies Approach (2nd ed., pp. 555-610). Philadelphia, PA: F.A. Davis Company. Gupta, K., Dhawan, A., Abel, C., Talley, N., & Attia, J. (2013). A re-evaluation of the scratch test for locating the liver edge. BMC Gastroenterology, 13, 35 40. doi: 10.1186/1471-230X-13-35