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The scratch test for determining the inferior hepatic margin

Thomas Millington Goodsall, Patrick Flynn and John R Attia
Med J Aust 2017; 206 (9): 386-387. || doi: 10.5694/mja16.01068
Published online: 15 May 2017

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.

  • Thomas Millington Goodsall1,2
  • Patrick Flynn2
  • John R Attia1,2

  • 1 University of Newcastle, Newcastle, NSW
  • 2 John Hunter Hospital, Newcastle, NSW


Acknowledgements: 

We thank Benjamin Oakley, Evelyn Tan and Ken Goon for their help as model and for audiovisual support.

Competing interests:

No relevant disclosures.

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