Examination of the spleen • Spleen is neither visible nor palpable; during examination it shows associated movements (synkinesis) with breathing. • The spleen enlarges inferiorly and medially from the left costal margin across the umbilicus to the right iliac fossa. • Difficulties in examination are caused by obesity, tension of the abdominal wall, meteorism, ascites. • Local evaluation of the finding is impeded with the enlarged left lobe of the liver, tumour of the left kidney and adrenal gland, tumour of the splenic flexure or the cauda of the pancreas. Splenomegaly can be visible in case of the extreme enlargement in asthenic. Patients. Physical examination is by: palpation, percussion – over the spleen, the percussion note is dull auscultation – rarely, revealing a friction rub. • In differentiating the spleen from an enlarged left kidney or a mass at the splenic flexure, note that: the spleen has no palpable upper border the spleen is not ballottable except in the presence of gross ascites. Degree of splenomegaly o Pronounced – is found especially in myelofibrotic syndrome, chronic myeloid leukaemia, or thrombosis of the portal vein. o Moderate – in lymphomas, thrombosis of the portal vein and liver cirrhosis. o Mild – present in infectious diseases (typhoid fever, brucellosis, infectious mononucleosis), sepsis, or infectious endocarditis. Sorenes pronounced in perisplenitis joined with splenic infarction (mitral stenosis, infectious endocarditis), simultaneous frictional murmur can be palpable and audible. Spleen Palpation 1- The examiner places the left hand over the patient’s chest and elevates the patient’s left rib cage. 2- The right hand is placed flat below the left costal margin and presses inward and upward toward the anterior axillary line. 3- The left hand exerts an anterior force to displace the spleen anteriorly. 4- The patient is instructed to take a deep breath as the examiner presses inward with the right hand. 5- The examiner should attempt to feel the tip of the spleen as it descends during inspiration. 6- The tip of the enlarged spleen will lift the fingers of the right hand upward. 7- The examination of the spleen is repeated with the patient lying on the right side. The examiner places the left hand on the patient’s left costal margin while the right hand palpates in the left upper quadrant. 8- The right hand should always palpate near the umbilicus and gradually move toward the left upper quadrant. 9- If the spleen tip was not palpable, the patient is put in the right lateral decubitus position with the legs somewhat flexed at the hips and knees. Use two-handed technique.
Posted on: Fri, 09 May 2014 18:43:52 +0000
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