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Clinical exam · Abdomen

Palpation of the liver and spleen !

  • Maneuver

Techniques to feel the edge of the liver and spleen under the ribs as the patient breathes in deeply, and tell whether they are enlarged.

Updated 2026-11-01

See it in 3D: Liver · Spleen · Diaphragm · Kidneys · Ribs (back part)

What it is

The liver and spleen move down with the diaphragm on each breath in, so they are felt with a still hand under the costal margin, waiting for the organ's edge to reach the fingers. Always start low, in the right iliac fossa, so that a very large organ is not missed. A normal spleen is almost never felt; if you can feel it, it is usually enlarged. Record the size below the margin, the edge, consistency, surface and tenderness.

The anatomy it tests

  • The liver fills the right hypochondrium and part of the epigastrium under the diaphragm; it descends on inspiration.
  • The spleen lies under the left ninth to eleventh ribs at the midaxillary line; as it grows it moves down and toward the right iliac fossa.
  • The left kidney is retroperitoneal with colon in front of it: it is resonant and can be balloted, unlike the spleen, which is dull and anterior.

How to do it

  1. Patient supine with knees flexed; examiner on the right.
  2. Liver: place the left hand behind the lower right ribs and push forward.
  3. Place the right hand in the right iliac fossa, lateral to the rectus, fingers pointing to the costal margin.
  4. Ask for a deep breath; keep the hand still and feel whether the liver edge taps the fingertips; move up two centimeters with each breath.
  5. Hooking alternative: standing by the right shoulder, hook the fingers of both hands under the costal margin and ask for a breath in.
  6. Spleen: reach over the patient with the left hand and lift the lower left ribs from behind.
  7. Move the right hand from the right iliac fossa diagonally toward the left costal margin, with each deep breath.
  8. If it is not felt, roll the patient onto the right side with the left hip and knee flexed and repeat.
  9. Record how many centimeters each organ extends below the margin, its edge, consistency, surface and tenderness.

What a positive result means

  • Large, smooth, tender liver: acute hepatitis or congestion from right heart failure.
  • Firm liver with a blunt, irregular edge: cirrhosis; hard and nodular: metastases or hepatocellular carcinoma.
  • Large liver that pulses in systole: tricuspid regurgitation.
  • Palpable spleen: portal hypertension, infections (mononucleosis, malaria, endocarditis), blood disorders (leukemias, lymphomas, myelofibrosis) or hemolytic anemias.
  • An organ that cannot be felt may still be enlarged; the exam underestimates size and ultrasound measures it.

Usefulness and limits

  • Starting too close to the costal margin: an organ reaching into the pelvis is missed.
  • Moving the hand during inspiration instead of letting the organ come to it.
  • A liver pushed down by emphysema or pleural effusion can be felt without being enlarged; add the percussed liver span.

Test yourself

Think of the answer, then tap the question to see it.

Why start palpating the liver and spleen in the right iliac fossa?

So that a very large organ whose edge already lies below the starting point is not missed.

In which position do you repeat spleen palpation if it is not felt supine?

Right lateral decubitus with the left hip and knee flexed, so the spleen falls toward the hand.

How do you tell a large spleen from a large left kidney?

The spleen has a notch, is dull, grows diagonally and you cannot get above it; the kidney is resonant from the colon in front and is ballotable.

What does a firm liver with an irregular edge suggest?

Cirrhosis or tumor infiltration (metastases or hepatocellular carcinoma).

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

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Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: Evaluation of the Gastrointestinal Patient - Gastroenterology - Merck Manual Professional Edition (Merck & Co., Inc., 2025); Enlarged liver: MedlinePlus Medical Encyclopedia (U.S. National Library of Medicine, 2025); Splenomegaly: MedlinePlus Medical Encyclopedia (U.S. National Library of Medicine, 2025).

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