Internal Diseases · MU Sofia

Practical · 20 Physical methods of examination of the liver

Explains how the liver is examined physically: patient positioning, inspection for abdominal distension and skin signs such as jaundice, palmar erythema and asterixis, then superficial and deep palpation with a table of palpable features (edge, surface, consistency, tenderness, pulsation, respiratory mobility). Covers percussion for span and borders, brief notes on auscultation for bruits, and the scratch test for the edge in obese patients.

Inside: 7 sections · 6 labelled pictures · 1 table · 16 flashcards · 3 min

Topic 77 of 88 in the MU Sofia syllabus for Internal Diseases (Dental Medicine, Year 4). The free AceMed note covers it in 7 sections, about 289 words (3 min of reading), with 16 flashcards.

In this note

  1. Physical Methods of Examination of the Liver
  2. I. General Considerations
  3. II. Inspection
  4. III. Palpation of the Liver
  5. IV. Percussion of the Liver
  6. V. Auscultation
  7. VI. Special Tests

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.

Features to Observe if Liver is Palpable:

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