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Related Experiment Videos

Is the undeniably palpable liver ever 'normal'?

D N Ralphs, G Venn, O Khan

    Annals of the Royal College of Surgeons of England
    |May 1, 1983
    PubMed
    Summary
    This summary is machine-generated.

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    Clinical examination often fails to accurately detect the normal liver edge extending below the costal margin. Relying on palpation alone may lead to misdiagnosis, suggesting an abnormal liver when it is not.

    Area of Science:

    • Hepatology
    • Clinical Diagnostics
    • Medical Imaging

    Background:

    • The liver's lower border typically lies below the costal margin in healthy individuals.
    • Accurate clinical identification of liver extension is crucial for diagnosing hepatomegaly.

    Purpose of the Study:

    • To assess the reliability of clinical examination in identifying the lower border of a normal liver extending below the costal margin.
    • To compare clinical findings with scintiscanning results in patients without evidence of liver disease.

    Main Methods:

    • Study included 42 patients with no clinical, biochemical, or scintigraphic evidence of liver disease.
    • Two independent clinicians performed physical examinations to identify liver extension below the costal margin.
    • Scintiscanning was used as a reference standard to confirm liver position.

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    Main Results:

    • Clinical observers agreed on liver extension in 10 out of 42 patients.
    • Scintiscanning revealed liver extension below the costal margin in 30 patients.
    • Two cases clinically identified as infracostal liver extension were found to be normal on scintiscan.

    Conclusions:

    • A normal liver commonly extends below the costal margin.
    • Clinical methods for detecting this normal extension are unreliable and no more accurate than chance.
    • Confident clinical identification of an infracostal liver should prompt further investigation for potential liver abnormality.