I. General Considerations
- Examination of the liver is done with the patient in a supine position, arms by the side.
- Knees can be slightly flexed to relax the abdominal muscles.
- The examiner stands on the right side.
- Important to observe the patient’s face and hands for liver-related signs before abdominal palpation.
II. Inspection
Although the liver is not directly visible, inspection may show:
- Abdominal distension in hepatomegaly or ascites.
- Visible bulging of right costal margin in massive enlargement.
- Dilated veins (caput medusae) in portal hypertension.
- Skin signs:
- Jaundice (yellowing)
- Spider angiomas
- Palmar erythema
- Gynecomastia
- Asterixis (flapping tremor)
- Scratch marks (from pruritus)
III. Palpation of the Liver
➤ Superficial Palpation
- To assess for tenderness, guarding, or muscle resistance in the right upper quadrant (RUQ).
➤ Deep Palpation
- Start in the right iliac fossa, moving upward toward the costal margin.
- Place your left hand behind the lower right ribcage to support the patient.
- Ask the patient to inhale deeply as your right hand presses gently under the costal margin.