Log in with your email address username.

×

Important notice

doctorportal Learning is on the move as we will be launching a new website very shortly. If you would like to sign up to dp Learning now to register for CPD learning or to use our CPD tracker, please email support@doctorportal.com.au so we can assist you. If you are already signed up to doctorportal Learning, your login will work in the new site so you can continue to enrol for learning, complete an online module, or access your CPD tracker report.

To access and/or sign up for other resources such as Jobs Board, Bookshop or InSight+, please go to www.mja.com.au, or click the relevant menu item and you will be redirected.

All other doctorportal services, such as Find A Doctor, are no longer available.

The scratch test for determining the inferior hepatic margin

- Featured Image

Still a valuable component of the physical exam

Evaluation of liver size by palpation is a basic component of the physical examination. Suspicion of an enlarged liver should prompt the clinician to examine for possible causes (Box 1) and investigate further with appropriate imaging such as ultrasonography. Palpation to detect the inferior liver margin may not be accurate or possible in certain clinical conditions (eg, obesity, abdominal distension, tenderness, or guarding). In such cases the scratch test may be useful. We describe the technique of the test and review the evidence base for its use.

The scratch test is a type of auscultatory percussion which was described as far back as 1840, and used to ascertain the size and form of various organs, including the heart and liver.2 The principle behind the scratch test is that the sound from a scratch on the skin overlying the relatively solid liver will be transmitted to a stethoscope located at another point over the liver better than a scratch not over the liver (ie, separated from the stethoscope by bowel or air).

Method for performing the scratch test3

  • The diaphragm of the stethoscope is placed on the xiphisternum (point C in Box 2).

  • The examiner repeatedly and lightly strokes…

    email