The upper border of a palpable liver should be percussed to ensure that the organ is not merely low-lying. Acute, tender enlargement may accompany hemorrhage into a cyst or the liver parenchyma. The quality of the liver on palpation is as important as its size. Normally, its edge is rubbery-soft, sharp, and smooth. This consistency is often maintained when the liver is enlarged because of acute hepatitis, fatty infiltration, passive congestion, or early biliary obstruction.
Audible friction rubs or bruits over the liver, although rare, are other valuable clues to tumor.
Liver tenderness is overdiagnosed, usually because of the patient's anxiety during palpation. It is most often felt in acute hepatitis, passive congestion, and malignancy. Spontaneous right upper quadrant discomfort is usually minimal in these disorders, but occasionally severe pain and tenderness may mimic an acute surgical condition. All rights reserved.