Physical Exam

Liver Palpation

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Video coming September 2026

How to Perform

Stand at the patient's right side and place your palpating hand flat on the right lower abdomen, lateral to the rectus muscle, with the fingers pointing toward the head. Press in and upward and ask the patient to take a deep breath, feeling for the liver edge to descend against your fingertips during inspiration. Step your hand upward toward the costal margin until you feel the edge, then note its contour and any tenderness. Percussing the liver span in the midclavicular line first helps locate the edge.

How to Interpret

Cirrhosis

Firm liver edge on palpation

Rule in

Somewhat helpful

Rule out

Somewhat helpful

Evidence:Strong

Hepatomegaly (palpable below costal margin)

Rule in

Somewhat helpful

Rule out

Somewhat helpful

Evidence:Strong

References

Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL, Schulzer M, Mak E, Yoshida EM. Does this patient with liver disease have cirrhosis? JAMA. 2012 Feb 22;307(8):832-842. doi:10.1001/jama.2012.186. PMID: 22357834.
Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL, Schulzer M, Mak E, Yoshida EM. Does this patient with liver disease have cirrhosis? JAMA. 2012;307(8):832-842. doi:10.1001/jama.2012.186 (PMID 22357834). JAMA Rational Clinical Examination SR/MA, 86 studies, n=19,533 patients (4,725 with biopsy-proven cirrhosis, prevalence 24%), random-effects bivariate meta-analysis. Table 2 'Firm liver' pool: 4 studies, n=849, sens 0.73, spec 0.81, LR+ 3.3 (95% CI 2.3-4.7) I²=57% p=.07, LR- 0.37 (95% CI 0.31-0.43) I²=0% p=.46.
Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL, Schulzer M, Mak E, Yoshida EM. Does this patient with liver disease have cirrhosis? JAMA. 2012;307(8):832-842. doi:10.1001/jama.2012.186. PMID: 22357834.
McGee S. Evidence-Based Physical Diagnosis. 6th ed. Philadelphia, PA: Elsevier; 2025.