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The normal position of the liver The liver is usually present in the upper quadrant of the abdomen. Its lower border is usually thought to be present under the right coastal margin.
What is liver span?
Liver span is the distance between the upper and lower border of the liver in the midclavicular line.
What is the normal liver span in children and adults?
The normal love span in adults is about 12-15 cm and in adults, it is about 6-8 cm.
Percussion of the liver
Percussion of the liver is the normal process while examining the abdomen along with other organs.
Is it necessary to percuss or palpate to measure the liver span?
The upper border of the liver is usually percussed while measuring the liver span. The lower border is usually palpated and then the liver span is measured by using a measuring tape.
Percussion of liver span
This term refers to measuring the span of the liver after finding the upper border of the liver by percussing it.
Principle of liver span measurement by percussion
The principle use while percussing the liver to measure its total span is that the percussion note is resonant in the intercostal spaces where lungs are present and the percussion note becomes dull where the liver is present. This change of note from resonant to dullness is known as an impaired note.
How to measure liver span by percussion?
Percussion of the upper border of the liver
Follow the following steps to percuss the liver span:
1. Palpate the manubriosternal angle (also known as the angle of Louis) in the midline. It is easily palpable as it is the most prominent point on the sternum in the midline.
2. Locate the second right rib along the angle of Louis. The space present below the second rib is the right second intercostal space.
3. Now put the middle finger of the left hand over the right second intercostal space parallel to the ribs.
4. Tap your finger with the middle finger of the right hand twice with movement essentially on the wrist joint and not on the elbow joint.
5. The percussion note normally heard is resonant due to the presence of lungs under this intercostal space which is filled with air.
6. Plapate the lower intercostal space and percuss it with a similar method discussed above.
7. Keep percussing all the intercostal spaces and also note the percussion note. As soon as you hear the dull or impaired percussion note, it indicates the presence of the upper border of the liver.
8. Mark that point in the midclavicular line as the upper border of the liver.
9. The lower border of the liver can also be percussed by the same method but it is not used in daily practice.
10. Palpation of the lower border of the liver
11. Put your right hand over the lower quadrant of the right side of the abdomen with the fingers facing upward and ask the patient to take deep breaths. Move your hand slowly upwards synchronizing with the respiratory movements. if enlarged, the liver will be palpated. Normally the liver is in its normal size and it is not usually palpable and is thought to be present under the right costal margin. So, the lower border is also marked in the midclavicular line.
12. Now take a measuring tape and measure the liver span between the two marked points. As mentioned above, it comes out to be about 12-15 cm.
Why it is important to know about the liver span in cm?
In some diseases, the liver may be enlarged. Measuring the liver span in centimetres by percussion is a reliable method and is used frequently in Medical practice. The most common disease in which the liver gets enlarged is portal hypertension. The process of enlargement of the liver is known as hepatomegaly and can be assessed by measuring the liver span.