There is conflicting, relatively low quality evidence regarding whether or not the scratch test can accurately determine the vertical liver span. However, there is better quality evidence that the vertical liver span has poor correlation with liver volume (since their is much greater variability in the overall shape of the liver between people than with other organs). Since it's the liver volume that correlates with pathology and not its span in a single dimension, neither the scratch test nor liver percussion are useful, even if we ignore the availability of ultrasound in most parts of the world. (EDIT: Relevant paper on the lack of usefulness of liver percussion, and by extension, of the scratch test: pubmed.ncbi.nlm.nih.gov/7661163/)
I wish I could write in my residency personal statement that my ultimate goal is to be just like Dr. Eric Strong. This would be very truthful and would also save me a few lines
Seems to me that the vast majority of these signs and exam findings are better assessed with POCUS and Doppler. Only the assessment of rebound tenderness/peritonitis and abdominal tenderness can't be done with imaging...
I Think only the middle Finger in kontakt with Abdomen kann produce better resonance or Dullness instead of Putting all the four Fingers on the Belly like in this Video. The Other thing is on Reaching the Dullness Point , you to shift the patient on the opposite Side sothat the Fluids shift tdown to that Direction und the Dullness converts in Resonance , called Shifting Dullness
Great video as always! Not only did I learn some nice things to teach on rounds, I learned at least 1 thing to use myself that I haven't done before. I was slightly surprised you didn't mention the scratch test for hepatomegaly, however. Do you dislike the scratch test, or just don't like it enough to include in the video? The way I've felt that it is useful is for trainees who feel they can't properly palpate the liver and don't know where to start. The scratch test is quick to learn and relatively easy for learners, who can then find where they think the liver edge is and then transition to standard palpation procedure as you describe. My gut, nonscientific impression has been that this has been helpful for learners' confidence and skill in exam, but I could be fooling myself.
I was also unsure of the significance of the liver scratch test as many doctors in my university did not use it. Dr Strong answered your question in a reply to another comment below :)
@@Mini1103ify Thank you, found it below. I think, after reviewing the paper he references (pubmed.ncbi.nlm.nih.gov/7661163/), that he's right that physical exam of the liver just isn't that helpful. I think I'll mostly quit teaching the scratch test just to avoid wasting learners' time. I just liked it because it was so much easier than palpation or percussion , at least for me.
Sorry, as I was editing both the archaic abdominal and CV maneuvers videos, I realized I was unsatisfied with parts of them, so needed reshoots. Unfortunately, I have to reserve the space far in advance and to work around the needs of med school courses and residency programs (they very justifiably have priority over me). Hopefully some time this fall!
Thank you very much please continue making these clinical examination videos
Such a great video! Thanks
Thank you
Thank you... I wanna to know the importance of liver contour auscultation to detect the size of liver ( liver scratch test )
Can you explain more?
There is conflicting, relatively low quality evidence regarding whether or not the scratch test can accurately determine the vertical liver span. However, there is better quality evidence that the vertical liver span has poor correlation with liver volume (since their is much greater variability in the overall shape of the liver between people than with other organs). Since it's the liver volume that correlates with pathology and not its span in a single dimension, neither the scratch test nor liver percussion are useful, even if we ignore the availability of ultrasound in most parts of the world.
(EDIT: Relevant paper on the lack of usefulness of liver percussion, and by extension, of the scratch test: pubmed.ncbi.nlm.nih.gov/7661163/)
Thank you so much❤ I'm satisfied
I wish I could write in my residency personal statement that my ultimate goal is to be just like Dr. Eric Strong. This would be very truthful and would also save me a few lines
Дякую за всю роботу, що ви робите для світової медицини!
Seems to me that the vast majority of these signs and exam findings are better assessed with POCUS and Doppler. Only the assessment of rebound tenderness/peritonitis and abdominal tenderness can't be done with imaging...
I Think only the middle Finger in kontakt with Abdomen kann produce better resonance or Dullness instead of Putting all the four Fingers on the Belly like in this Video. The Other thing is on Reaching the Dullness Point , you to shift the patient on the opposite Side sothat the Fluids shift tdown to that Direction und the Dullness converts in Resonance , called Shifting Dullness
Can i get your consultation?
Thank you very much !!
Thank you sir ❤️❤️❤️❤️❤️
Great video as always! Not only did I learn some nice things to teach on rounds, I learned at least 1 thing to use myself that I haven't done before. I was slightly surprised you didn't mention the scratch test for hepatomegaly, however. Do you dislike the scratch test, or just don't like it enough to include in the video? The way I've felt that it is useful is for trainees who feel they can't properly palpate the liver and don't know where to start. The scratch test is quick to learn and relatively easy for learners, who can then find where they think the liver edge is and then transition to standard palpation procedure as you describe. My gut, nonscientific impression has been that this has been helpful for learners' confidence and skill in exam, but I could be fooling myself.
I was also unsure of the significance of the liver scratch test as many doctors in my university did not use it. Dr Strong answered your question in a reply to another comment below :)
@@Mini1103ify Thank you, found it below. I think, after reviewing the paper he references (pubmed.ncbi.nlm.nih.gov/7661163/), that he's right that physical exam of the liver just isn't that helpful. I think I'll mostly quit teaching the scratch test just to avoid wasting learners' time. I just liked it because it was so much easier than palpation or percussion , at least for me.
I could not find the video on archaic manouvers. Will it be released in the future?
Thanks so much for your work!
Sorry, as I was editing both the archaic abdominal and CV maneuvers videos, I realized I was unsatisfied with parts of them, so needed reshoots. Unfortunately, I have to reserve the space far in advance and to work around the needs of med school courses and residency programs (they very justifiably have priority over me). Hopefully some time this fall!
@@StrongMed No problem, thank you for your answer! I'll be looking forward to that video!
Best in class videos!!
My mentor is back again ❤
Thank you so much for being there for us. You are matchless and phenomenal.
Thank you for your work, eric!
that's very helpful
Thank you!