PHYSICAL-EXAMINATION OF THE LIVER - IS IT STILL WORTH IT

Objectives: The aim of this study was to evaluate the actual role of p hysical examination of the liver in normal subjects and in cirrhotic p atients, Methods: One hundred healthy subjects and 100 patients with l iver cirrhosis underwent a physical and an ultrasonographic evaluation of the liver by independent operators. Physical examination was perfo rmed by means of percussion and palpation to determine total liver spa n, liver span below the costal margin, and liver consistency, Total li ver span, liver span below the costal margin and liver volume were als o determined by means of ultrasonography. Results: The agreement betwe en physical and ultrasonographic assessment of the liver span below th e costal margin was poor in controls (chance corrected agreement index = 0.13) and excellent in patients (chance corrected agreement index = 0.93). Physical and ultrasonographic total liver span were correlated in patients with cirrhosis (r = 0.592) but not in controls (r = 0.205 ). Echo-measured liver span significantly correlated with the actual v olume of the organ in both groups, whereas physical liver span signifi cantly correlated with liver volume in cirrhosis but not in controls. The difference between actual liver volume and the value predicted by liver span was large, The cirrhotic liver was slightly reduced in size in comparison with that of healthy subjects and differed by an increa se in consistency and a thickened edge. Conclusions: The bedside exami nation of the liver does not provide any accurate information regardin g the actual volume of the organ. Its major role remains to define the characteristics of lower edge, mainly consistency, which may help in clinical diagnosis, Liver volume proved to predict prognosis in patien ts with cirrhosis, but its measurement needs quantitative, reproducibl e methods, which can be obtained only by imaging techniques.