History

Liver History

Inspection

Extra-hepatic Stigmata of Liver Disease

• Mental status (2)
• Head and neck (4)
• Diagram

Percussion

Upper and lower border

• @ Right mid-clavicular line
  1. Lower boarder:
     • RLQ (Level of ASIS) → Right costal margin (transition to dullness)
  2. Upper border:
     • Nipple → RUQ (transition to dullness)
  • Normal liver span: 6-12 cm

Palpation

Lower border

• Standard technique
• Hooking technique (Obese patient)

Normal edge (soft, discrete and smooth), Tenderness

• Cirrhotic: rough and nodular

Auscultation is not a standard part of liver physical exam, but you could listen to bruits, friction rubs, and venous hums