This section is from the "Impaired Health: Its Cause And Cure" (Volume 1) book, by John H. Tilden. Also available from Amazon: Impaired health its cause and cure: A repudiation of the conventional treatment of disease
A fullness is observed under the ribs on the right side. Tumefaction of the spleen co-exists. When it does, there is tumefaction of the upper half of the abdomen. This is especially noticeable when the patient stands. The liver is more developed in children than in adults.
To determine the amount of enlargement, place the patient on his back with legs flexed, and begin the palpation and percussion on the lower abdomen, gradually going up toward the ribs. In enlargement the dull, flat sound will be found anywhere below the ribs, depending upon the amount of enlargement. Under normal conditions the flat sound begins two fingers' breadth below the nipple, and terminates at the costal border (border of the ribs).
The liver is prolapsed when the flatness is below the points mentioned.
The border of the upper line of the liver is on a line drawn from the right border of the sternum at the level of the sixth costal cartilage. It then follows the sixth rib to the right mammary line, and reaches the seventh rib on the axillary line, the ninth on the scapular line, and ends, at the spine, at the eleventh rib. Strong percussion is needed above to bring out the dullness, but light percussion is sufficient below.
Normally the lower limit of the liver may be confounded with kidney flatness at the axillary or the scapular line. The liver extends from the eleventh rib, following the costal border midway between the ensiform cartilage and the umbilicus, and terminates in the left side at the level of the apex of the heart. Liver flatness is diminished when there is emphysema of the lungs, gas distention of the stomach or bowels, or distention from ascitic effusion.
Atrophy of the liver occurs in cirrhosis and yellow atrophy.
General hypertrophy occurs in alcoholism, and the enlargements occasioned by liver and heart derangement brought on from excessive eating of starch and sweets,