Normally not palpable. Sometimes it is.
Surface = smooth and uniform.
Normal size by percussion=
< 5 cm in the RSB (right sternal border).
< 10 cm in the MCL (mid-clavicular line).
< 12 cm in the AAL (anterior-axillary line).
Border: Superior = 5th rib.
Mobility: Descends 1 to 3 cm, with deep inspiration.
Estimate:
Site
Shape
Volume
Surface
Mobility
Consistency
(nodular, hard-soft, irregular, granular, pulsatile).
Tenderness
Temperature
Megaly
Palpation Maneuvers
1) "Bimanual" ("Chauffard"): left hand in costo-lumbar angle, right hand palpates parallel to the
rectus.
2) " Hooking" ("Mathieu"): Physician on the right side of the Patient (facing toward the Patient's
feet), work the pulps of the fingers upward to the RUQ (right upper quadrant).
3) "Glenard": left hand lifts the lumbar region, right hand palpates the RUQ.
4) "Schmiedt": Physician behind the seated patient, liver descends with gravity.
5) "Iceberg's sign" (ballottment): sudden pressure over the right hypochondrium, the liver
rebounds -with hepatomegaly and ascites-.
See the
Abdomen
page.