Palpation of the liver begins in the right iliac fossa with the examining hand aligned parallel to the right costal margin.
Ask the patient to breathe in and out slowly; the liver moves down during inspiration so that its anterior edge becomes palpable if this extends beyond the costal margin.
With each expiration, press the radial border of the index finger into the abdomen; retain this position during inspiration.
Advance the examining hand 1 or 2 cm up towards the costal margin and repeat. Keep palpating until a liver edge is felt or the ribs are encountered. If an edge is felt, report its size in finger or hand breadths below the costal margin, and the other physical features of surface, tenderness, pulsatility etc.
Repeat the manoeuvre to the left of the midline to detect an enlarged left liver lobe.
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