Quick tip: palpating for a liver edge

The upper surface of the liver is at the level of the fifth intercostal space on the right side and the lower border is at the costal margin. Therefore in healthy adults you often cannot palpate a liver edge.

The liver should always be palpated on inspiration to maximise the potential for a normal or pathological liver edge to be felt. Because the liver is situated just under the diaphragm, the liver will move inferiorly on inspiration as the diaphragm contracts and moves down itself.

Always palpate from the right iliac fossa up to the costal margin. Place your hand lightly on the patient’s abdomen and ask your patient to take deep breaths in and out. Palpate more firmly as your patient breathes in and attempt to feel the liver edge.

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Quick tip: percussion

When percussing, most of us will percuss twice in the same spot before moving across the chest or abdomen. Remember to ensure that on the second tap, you remember to immediately lift your percussing finger off at the end, just like you did for the first tap. If you don’t, the first and second notes will not elicit the same resonance or dullness. Specifically, you will get a relatively more dull percussion note is your percussing finger is left down longer.