[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Abdomen](https://durgical.com/en/clinical-exam/#a-abdomen) › Palpation of the liver and spleen [Clinical exam](https://durgical.com/en/clinical-exam/) · [Abdomen](https://durgical.com/en/clinical-exam/#a-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](https://durgical.com/en/anatomy/liver/) · [Spleen](https://durgical.com/en/anatomy/spleen/) · [Diaphragm](https://durgical.com/en/anatomy/diaphragm/) · [Kidneys](https://durgical.com/en/anatomy/kidney/) · [Ribs (back part)](https://durgical.com/en/anatomy/ribs/) ## Key points - Liver: right hand in the right iliac fossa, parallel to the rectus border, fingers pointing up; move up in steps as the patient breathes in deeply. - Normal liver: a thin, smooth, soft edge that may be felt just below the costal margin on deep inspiration. - Spleen: the left hand lifts the lower left ribs from behind; the right hand moves from the right iliac fossa toward the left costal margin. - If it is not felt with the patient supine, repeat with the patient on the right side, left hip and knee flexed. - The spleen enlarges diagonally toward the right iliac fossa, has a notch and you cannot get above it; the kidney can be got above and is ballotable. - Palpate a large spleen gently, for example in mononucleosis, because it can rupture. ## 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 - Patient supine with knees flexed; examiner on the right. - Liver: place the left hand behind the lower right ribs and push forward. - Place the right hand in the right iliac fossa, lateral to the rectus, fingers pointing to the costal margin. - 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. - Hooking alternative: standing by the right shoulder, hook the fingers of both hands under the costal margin and ask for a breath in. - Spleen: reach over the patient with the left hand and lift the lower left ribs from behind. - Move the right hand from the right iliac fossa diagonally toward the left costal margin, with each deep breath. - If it is not felt, roll the patient onto the right side with the left hip and knee flexed and repeat. - 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). [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/clinical-exam/palpation-of-the-liver-and-spleen/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Liver](https://durgical.com/en/anatomy/liver/) - [Spleen](https://durgical.com/en/anatomy/spleen/) - [Diaphragm](https://durgical.com/en/anatomy/diaphragm/) - [Kidneys](https://durgical.com/en/anatomy/kidney/) - [Ribs (back part)](https://durgical.com/en/anatomy/ribs/) ## Related - [Abdominal palpation: light and deep, guarding and masses](https://durgical.com/en/clinical-exam/abdominal-palpation-light-and-deep-guarding-and-masses/) - [Abdominal percussion: liver span and tympany](https://durgical.com/en/clinical-exam/abdominal-percussion-liver-span-and-tympany/) - [Kidney palpation: bimanual palpation and ballottement](https://durgical.com/en/clinical-exam/kidney-palpation-bimanual-palpation-and-ballottement/) - [Ascites: shifting dullness and fluid wave](https://durgical.com/en/clinical-exam/ascites-shifting-dullness-and-fluid-wave/) - [Portal hypertension and the signs of chronic liver disease](https://durgical.com/en/clinical-exam/portal-hypertension-and-the-signs-of-chronic-liver-disease/) ## Related conditions - [Cirrhosis](https://durgical.com/en/conditions/cirrhosis/) - [Portal hypertension](https://durgical.com/en/conditions/portal-hypertension/) - [Viral hepatitis](https://durgical.com/en/conditions/viral-hepatitis/) - [Hepatocellular carcinoma](https://durgical.com/en/conditions/hepatocellular-carcinoma/) - [Metabolic dysfunction-associated steatotic liver disease (MASLD/NAFLD)](https://durgical.com/en/conditions/metabolic-dysfunction-associated-steatotic-liver-disease/) [← All of the clinical exam](https://durgical.com/en/clinical-exam/) 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](https://www.merckmanuals.com/professional/gastrointestinal-disorders/approach-to-the-gastrointestinal-patient/evaluation-of-the-gastrointestinal-patient) (Merck & Co., Inc., 2025); [Enlarged liver: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/003275.htm) (U.S. National Library of Medicine, 2025); [Splenomegaly: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/003276.htm) (U.S. National Library of Medicine, 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/palpation-of-the-liver-and-spleen/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/palpation-of-the-liver-and-spleen/