So now we're going to perform the liver ultrasound. So for liver ultrasound, you want to position the patient in a supine position. Once again, their legs are going to be bent to relax abdominal muscles.
You can position the patient's arm above to kind of expose the ribs, open up the rib spaces to look for the liver. You want to start around the ninth or tenth rib space in the mid-axillary line. The indicator of a phased array probe or a curvilinear probe is going to be towards the patient's head. And this is going to be in the standard ultrasound setting.
So the indicator on the screen is on the left side of the screen. So here I'm going to place the probe on the patient's 9th or 10th intercostal space, looking for that liver. So here you can see a nice view of the liver.
I'm going to increase the gain. And what you want to identify for the liver from superior to inferior is the lung is the most superior. And what you see there is what's called a mirror artifact. And that's because sound waves travel through the liver and it contacts. diaphragm, it reflects back and causes what looks what's called a mirror artifact.
And that's completely normal because air scatters ultrasound waves. And it looks like you have another liver above your diaphragm and that is completely normal. So below the lung is your diaphragm, that hyperchoic or really bright structure above the liver. And below that is your actual liver.
And you can see the grayish. appearance of the liver and below the liver as I scan down I'm pushing my probe more towards his feet you can see the kidney, the right kidney. And in between the liver and the right kidney is called Morrison's pouch.
This is where free fluid often accumulates. Free fluid or ascites, either ascites or blood, can accumulate in Morrison's pouch, and often it can go towards the patient's liver tip. So make sure you scan towards the liver tip.
tip when you're doing a scan of the right upper quadrant here. This is also a great view to look for hepatomegaly. And you can measure that from the top of the diaphragm here to the edge of the liver inferiorly there. You can also look at the echogenicity of the liver to see if it's bright, consistent with chronic scarring or cirrhosis, or very dark. which would indicate hepatitis because of the fluid inside the liver with the inflammation.