Polithicsssssssssss

GOVERNMENT EXPLAINED:

FEUDALISM

You have two cows.Your lord takes some of the milk.

FACISM

You have two cows.The government takes both, hires you to take care of them, and sells you the milk.

RUSSIAN COMMUNISM

You have two cows.You count the cows and find that you have four cows. You count again and, you now have 40 cows. You count again and finally find out that you have two cows. You don't care and simply pour another shot of Vodka.

DICTATORSHIP

You have two cows.The government takes both the cows and drafts you.

PURE DEMOCRACY

You have two cows.Your neighors decide who gets the milk.

BUREAUCRACY

You have two cows.At fist the government regulates what you can feed them and when you can milk them.Then it pays you not to milk them. Then it takes both, shoots one, milks the other and pours the milk down the drain.Then it requires you to fill out forms accounting for the missing cows.

SURREALISM

You have two girrafes.The government requires you to take the harmonica lessons.

COMMUNISM

You have two cows.The government takes both and gives you the milk.

NAZISM

You have two cows.The government takes both and shoots you.

CAPITALIS

MYou have two cows.You sell one and buy a bull.

NEPALESE DEMOCRACY

You have two cows.You sell one, buy a bull;take out huge loan on the cow, and ignore both the cow and loan from that point on; then you try to milk the bull, and blame the Japanese for its lack of production.

Technique of palpation of liver

Techniques:
Liver
Approach the examination of the liver from the right side of the patient. Have the patient lying supine. Preserve the patient’s privacy by draping the top of their body with the gown and below the waist with a sheet. For the best exam, make sure the patient is warm and comfortable. Additionally make sure your hands are warm so as to not startle the patient.

InspectionLook for gross asymmetries across the abdomen. Look at the skin for signs of liver disease, such as caput medusa, or spider angiomata.

AuscultationFollow the inspection of the liver, as with the rest of the abdominal exam, with auscultation. Listen over the area of the liver for bruits or venous hums.

Percussion for the upper and lower margins of the liver. Place your non-dominant hand palm down flat on the abdomen with the fingers parallel to the lower costal margin pointed toward the midline. Percuss with the middle finger of your dominant hand on the middle finger of your non-dominant one.
Begin percussion over the lungs and move from the area of resonant lung sounds to the areas of dullness. Mark the area of change. Repeat the same process from below, moving again from resonance over the bowel to dullness and again mark the area of change. Start in the lower right quadrant so as to not miss a greatly enlarged liver. Measure the vertical distance from the top to the bottom. You can also use palpation to determine the lower border.

PalpationBegin palpation over the right lower quadrant, near the anterior iliac spine. Palpate for the liver with one or two hands palm down moving upward 2-3 cm at a time towards the lower costal margin. Have the patient take a deep breath. The liver will move downward due to the downward movement of the diaphragm. Feel for the liver to hit the caudal aspect of your palpating hand. Palpate the bottom margin of the liver for the texture of the liver, i.e. soft/ firm/hard/nodular.

Scratch TestSeveral different techniques have been described for this exam. One is to place the diaphragm over the area of the liver and then scratch parallel to the costal margin until the sound intensity drops off marking the edge of the liver. Other techniques involve different patterns of the scratching, for example as in spokes of a wheel and other places for placing the stethoscope such as over the abdomen.
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