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June 15, 1994

Physical Examination of the Liver

Author Affiliations

From the Clinical Epidemiology Unit and the Division of General Internal Medicine, Sunnybrook Health Science Centre, Toronto, Ontario, and the Departments of Medicine and Surgery and the Graduate Department of Community Health, University of Toronto (Ontario).

JAMA. 1994;271(23):1859-1865. doi:10.1001/jama.1994.03510470063036

CLINICAL SCENARIO  The patient in your examining room is new to the practice. He is 52 years old, emigrated from Southeast Asia about 10 years ago, and has no specific complaints except fatigue. On examination you find little of note except that his liver edge is firm, easily felt, and extends about 6 cm below the costal margin across much of the right upper quadrant. The span, by light percussion, is 17 or 18cm. Should you be concerned? What does the research literature tell us about the meaning of these findings?Ideally, the clinical meaning of physical examination findings should be established in research studies that account for the overall context, including other signs and details from the medical history. This approach is difficult in liver disease, because the physical manifestations of hepatic dysfunction are protean and many multisystem diseases affect the liver. Our focus, therefore, is on physical examination