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10. Batas atas liver berada dua jari di bawah arcus costae dextra.

The patient physical examination shows the liver... Up to now, a considerably accurate way

to measure the size of liver is by palpation.

According to Stanford School of Medicine, the normal upper liver border is following 5-7-9rule. It means the upper border of liver is in:

5th intercostal space in the midclavicular line 7th intercostal space in the midaxillary line, and 9th intercostal space in the scapular line(inferior border of scapula).Another result different with that rule may indicate a pathological condition. The lowering of

liver upper border can be cause by the abnormal condition of the liver or the liver is only affected by

another organ.

A book I found in NCBI said that a patient with emphysema would have a lower liver upper and

lower border because the patient lung is hyperexpanded and his diaphragma is also flattened. In

another case, large right pleural effusion would do the same, but in this case its hard to distinc the

dullness of effussion or yhe liver. The complete differential diagnosis of liver percussion pathology

shown in the table below:

Table xxx. Examination Findings Associated with Specific Liver Diseases

Liver disease Palpation Size

Acute hepatitis Smooth; surface tender Enlarged

Chronic hepatitis Firm liver edge Enlarged, especially left lobe

Nodules rare; tender

Fulminant hepatitis Tender surface Shrinking size

Cirrhosis Nontender, firm Variable; late stages, liver decreases

in size

Hepatocellular carcinoma

(hepatoma)

Nodules, if present, large and

hard

Moderate to massive enlargement

Nontender

Metastatic carcinoma Large nodules Enlarged

Nontender

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Liver disease Palpation Size

Fatty liver Smooth surface Enlarged

Right heart failure Firm, smooth, tender Mild to massive enlargement

In primary liver cancer, the consistency of liver is infiltrated by cancer cells which grow rapidly. The

same enlargement occurs in lymphoma. Beside, in fatty liver the liver is enlarged by infiltration of

fatty hepatocytes and the enlargement of them.

Text citation:

Wolf DC. Evaluation of the Size, Shape, and Consistency of the Liver. In: Walker HK, Hall WD, Hurst

JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition.

Boston: Butterworths; 1990. Chapter 94. Available from:

http://www.ncbi.nlm.nih.gov/books/NBK421/

http://stanfordmedicine25.stanford.edu/the25/pulmonary.html

table citation:

Wolf DC. Evaluation of the Size, Shape, and Consistency of the Liver. In: Walker HK, Hall WD, Hurst

JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition.

Boston: Butterworths; 1990. Chapter 94. Available from:

http://www.ncbi.nlm.nih.gov/books/NBK421/

http://www.ncbi.nlm.nih.gov/books/NBK421/http://www.ncbi.nlm.nih.gov/books/NBK421/http://stanfordmedicine25.stanford.edu/the25/pulmonary.htmlhttp://stanfordmedicine25.stanford.edu/the25/pulmonary.htmlhttp://www.ncbi.nlm.nih.gov/books/NBK421/http://www.ncbi.nlm.nih.gov/books/NBK421/http://www.ncbi.nlm.nih.gov/books/NBK421/http://stanfordmedicine25.stanford.edu/the25/pulmonary.htmlhttp://www.ncbi.nlm.nih.gov/books/NBK421/