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.
Topic 19 of 30 in the MU Sofia syllabus for Internal Medicine (Practical) (Medicine, Year 3). The free AceMed note covers it in 7 sections, about 289 words (3 min of reading), with 16 flashcards.
In this note
Physical Methods of Examination of the Liver
I. General Considerations
II. Inspection
III. Palpation of the Liver
IV. Percussion of the Liver
V. Auscultation
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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