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Percussion of liver .How it is done?

Percussion of Upper border of liver
  • It is defined by tidal percussion  usually situated in 5th Right intercostal space in mid clavicular line
  • It is a heavy percussion because the upper border of liver lies under cover of the right lung.
  • Upper and lower border of right lobe of liver can be mapped out.
  • Place the pleximetcr finger in the right 2nd ICS parallel to arbitrary upper border of liver and the line of percussion will be perpendicular to that border.
  • Start percussion from above downwards in the right chest along the right MCL.where the note will be resonant over lungs and work downwards vertically.
  • In normal liver, upper border is at 5th inter costal space where note is dull; This extends down to the lower border found at or just below right subcostal margin.
  • Percussion below the right costal margin is useful in hepatomegaly. Ask the patient to breathe in deeply as you percuss, lightly keeping the fingers parallel to the the margin. As the liver descends during inspiration, a change in note from resonance to dull signifies liver edge.
Percussion of the lower border of liver :
  • Start percussion from below upwards i.e. from right iliac fossa lo right hypochondrium along the right MCL. 
  • Light percussion is done as it is a superficial organ.
  • Place the pleximeter finger parallel lo right subcostal margin and the line of percussion will be perpendicular to that margin.
  • Lower border of lung is found to lie in 6th rib. 8th rib and 10th rib in the MCL. midaxiilary and scapular line respectively.
How to assess the Liver span?
It is the measurement of liver size from the upper border to the lower border in the mid-clavicular line.
Normal liver span is 12.5 cm (12 - 15 cm)
Liver dullness is obliterated in following conditions
  • Severe emphysema
  • Right pneumothorax
  • Gas under the diaphragm [perforation of a viscus)
Shrunken liver Massive hepatic necrosis in fulminant hepatocellular failure , Advanced cirrhosis of liver.
Serial measurement of liver span is done to find out shrinkage or enlargement.