Rule Out Hepatic Tenderness

To elicit hepatic tenderness, place the palm of your left hand over the patient's right upper quadrant and gently hit it with the ulnar surface of the fist of your right hand. Inflammatory processes involving the liver or gallbladder produce tenderness on fist palpation. Figure 17-26 demonstrates this technique.

On occasion during liver palpation, pain is elicited in the left upper quadrant during inspiration, and the patient suddenly stops inspiratory efforts. This is called Murphy's sign and is

Figure 17-24 Technique for ''hooking'' the liver.

Figure 17-24 Technique for ''hooking'' the liver.

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