Liver mass physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2] Aditya Ganti M.B.B.S. [3]

Physical examination findings of liver mass will depend on location and size of the tumor. Usually large liver tumors may cause pain and tenderness in palpation of the abdomen due to stretching of the liver capsule. On the other hand, liver masses with smaller size can present with no remarkable findings. Common physical examination of patients with liver mass, may include jaundice, hepatomegaly, abdominal tenderness, splenomegaly, abdominal wall vascular collaterals, and weight loss.

The following physical examination findings may be present among patients with liver mass:^{[1][2][3][4][5][6][7]}

• Patients could be well appeared. However, some of them, based on the etiology and stage might be:
  • Lethargic
  • Cachectic
  • Confused

• High-grade or low grade fever
• Tachycardia
• Tachypnea
• Decreased SPO2

Inspection

• Chest alopecia
• Rapid rate of breathing

Auscultation

• Decreased/absent breath sounds

Percussion

• Dull percussion
• Reduced chest expansion

Inspection

• Caput medusae
  • Appearance of distended and engorged superficial epigastric veins

Auscultation

• Perform the liver scratch test
  • Useful for liver size determination
• Cruveilhier-Baumgarten murmur
  • Described as a venous hum in patients with portal hypertension
  • Present in patients with cirrhosis

Percussion

• Dull percussion

Palpation

• Abdominal distention
• Tenderness in right upper quadrant
• Hepatomegaly
• Splenomegaly

• Peripheral edema
• Muscle rigidity
• Hypertrophic osteoarthropathy

Inspection

• Pallor
• Jaundice
• Plantar and palmar erythema
• Dermatographic urticaria, or “scratching marks”
• Nail changes

• Muehrcke nails
• Terry nails, or “leukonychia“

• Lymphadenopathy

• Confusion
• Asterixis

• Clubbing of fingers
• Swelling of hands and feet
• Weakness
• Absent pulse