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How to examine for pulsatile liver ?

  • The patient is asked to sit in chair 
  • Place your right palm over the liver or right hypochondrium and the left palm over the back, just opposite to the right palm. 
  • You should stand on the right side of the patient.
  • Ask the patient to hold his breath after taking deep inspiration.
  • Look from the side and observe the separation of the hands along with expansile pulsation of
  • the liver.
The most common cause of pulsatile liver is CCF  which produces functional tricuspid incompetence Hence, while examining the pulsatile liver, always look for engorged and pulsatile neck veins,and bipedal oedema for indirect evidence of CCF. 
Common causes of pulsatile liver are
  • Cardiac failure (functional TI)
  • Organic tricuspid incompetence (systolic pulsation).
  • Tricuspid stenosis (presystolic pulsation).
  • Haemangioma of liver.
  • Transmitted epigastric pulsation (from RVH).