title: Palpable epigastric liver as a physical sign of cirrhosis: a prospective study.
abstract: OBJECTIVE
  Large numbers of patients present with abnormal liver function tests, but only a minority have significant liver disease. Physical examination may help in identifying patients with significant liver disease and in selecting patients who may require liver biopsy. Over a number of years we noted that a palpable liver in the epigastrium was common in patients with cirrhosis. The aim of this study was to evaluate this clinical sign in a cohort of patients undergoing liver biopsy.
  
  
  METHODS
  We prospectively studied 138 consecutive patients undergoing liver biopsy in a university teaching hospital. The main outcome measure was liver fibrosis measured using the standard METAVIR scoring system.
  
  
  RESULTS
  Thirty-eight patients had no fibrosis on biopsy, 11 patients had grade 1, eight patients had grade 2, 14 patients had grade 3 and 42 patients had grade 4 (cirrhosis). Palpable epigastric liver had a sensitivity of 86% and a specificity of 67% for the diagnosis of cirrhosis in this cohort.
  
  
  CONCLUSIONS
  We suggest that a palpable liver in the epigastrium is a useful physical sign of cirrhosis in clinical practice.
authors.affiliation: National Liver Transplant Unit, Department of Histopathology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland. amccormick@oceanfree.net
authors.forename: P A
authors.initials: PA
authors.lastname: McCormick
authors.forename: N
authors.initials: N
authors.lastname: Nolan
mesh_terms: D000005:Abdomen; D001706:Biopsy; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010173:Palpation; D011446:Prospective Studies; D012680:Sensitivity and Specificity