Palpation of liver (various techniques)

Definition:A healthy liver is not easily palpable although sometimes the liver edge can be felt in normal individuals at the peak of inspiration with the examiner’s fingertips applying pressure just below the costal margin in the right upper quadrant.

Test procedure: With the patient supine and with the knees supported with a cushion (aiding abdominal muscle relaxation).
First assess the patient with light palpation, starting in the lower quadrant and moving towards the right costal marginĀ . For light palpation start by only using one hand to gently (using the fingers) examine to check for any superficial tenderness, to gauge level of discomfort and to check for any small masses.

Then commence deep palpation using a two handed technique where the upper hand presses into (applying pressure) to the lower hand (in contact with the patient’s skin) concentrates on feeling. To palpate the liver start just below the umbilicus and move towards the liver area in the right upper quadrant feeling the for the liver edge particularly on inspiration

Test findings:
Enlarged livers could be felt below the costal margin and have a firm but slippery texture.
An enlarged liver infiltrated by tumours may be palpable in some individuals as an irregular surface.
A liver with severe cirrhosis as it shrinks in mass may not protrude or be palpable below the costal margin.

Please note those with overtly obese or those with excessive muscular development will make palpation more of a challenge.