What is the likely next step for a patient with longstanding COPD and an enlarged liver found during an examination?

In evaluating a patient with longstanding COPD and an enlarged liver, measuring the span of the liver is a crucial next step. This measurement helps to quantify the degree of hepatomegaly, which is particularly important in understanding the underlying pathology. In cases of COPD, enlargement of the liver can occur due to various factors, including hypoxia-related changes or the effects of medications used in symptom management, such as steroids.

By measuring the liver span, the clinician can assess whether the enlargement is consistent with conditions such as heart failure, where liver congestion may lead to hepatomegaly or other liver-related pathologies. This assessment is a foundational aspect of the physical examination and aids in determining if further diagnostic steps need to be taken based on the severity and implications of the liver enlargement.

The options of percussing the lower border of the liver and obtaining an ultrasound of the liver, while potentially useful later, do not provide the same immediate quantifiable information regarding the extent of liver enlargement. Ordering a hepatitis panel, though important in a different context, may not be the next logical step if the primary concern is to assess the size and potential implications of the liver enlargement seen on examination. Therefore, measuring the liver span directly addresses the immediate clinical concern.