Method and order of liver percussion

In a normal person performing a physical examination of a normal, more proportionate patient, the patient’s liver is percussed, first from the right midclavicular line from above to below. The upper border of the liver is the fifth intercostal space, and the lower border is located at the intersection of the right midclavicular line and the lower right costal margin, and the distance between them is the upper and lower diameter of the liver. Its range is roughly between 9-11 cm and is generally no greater than 12 cm. In addition, on the right midaxillary line, its upper border is the seventh intercostal space and its lower border is equivalent to the tenth intercostal space. On the right subscapular angle line, its upper border is the tenth intercostal space. For a well-proportioned patient, the upper and lower diameters of the liver are generally within this range. However, in short, fat patients, the upper and lower borders can be one intercostal space higher on this range. In addition, in long, thin patients, it can be one rib space below. On physical examination of the patient, the lower border of the liver is usually below the rib cage and is mostly not palpable. If an enlarged liver is palpable, the patient is considered to have an enlarged liver and further examination is needed to find the cause.