Surface markings of the liver
When examining a patient, it is important to recognise where the internal organs lie relative to the surface anatomy you can see. The liver can essentially be visualised as a triangle, with its upper margin below the nipples on either side of the chest, and the lower margin making a line from just above the tenth rib on the right side to below the nipple on the left side. The superior surface of the liver lies just below the diaphragm; this means that the lower margin of the liver will move downwards on inspiration, and this can be palpated. As the liver is also a very dense organ, it is very dull to percussion and you can easily percuss out the borders of the liver if palpation is unsuccessful.
The gallbladder area can be palpated around the tip of the right ninth rib. The normal gallbladder is impalpable; it only becomes palpable when distended with stones or bile, and the area will become very tender if there is inflammation present.
