Palpation of abdomen structures

Principles

• Always stand on the right side of the patient(if you are right-handed)
• Get the patient to lie supine on the bed
• Ask the patient to flex the legs at knee joint
• Expose the abdomen up to the chest and below up to the inguinal canal. Ask the patient if there is any tenderness before palpating
• Ask the patient to take deep breaths. Breathe in through the nose and breath out through the mouth 
• You can request the patient to look to the other side -opposite to the side you are standing so that the patient doesn’t breath on your face
• Rub your hands together to warn them before palpating
• Always palpate the child is breathing out(expiration) 

Points to note with abdominal palpation

• Surface temperature
• Tenderness
• Consistency
• Localised/ Movable
• Pulsations
• Divarication of rectus
• The flow of direction of blood in dilated abdominal veins
• Ascites with grading

Palpating the spleen

There are many ways to palpate the spleen.

• Stand to the right side of the patient
• Expose the abdomen from the ribcage to the pubis symphysis

Method 

• Place the palm of the right hand on the right iliac fossa and move upward and laterally towards the left hypochondrium
• Palpate all the way until the border of your right index finger touches the left costal margin
• Ask the child to take deep breaths and try to feel the border in inspiration

Percussing for the spleen

• Get the patient to sit with their hands on their head to expose the left side of the abdomen.
• Percuss the left axilla on the midaxillary line from left axilla downwards. 
• You should feel it dull a 7th, 8th, 9th intercostal spaces.
• You can percuss along the midclavicular space, but the enlarged spleen is discoverable earlier at the midaxillary line

Points to consider in splenomegaly 

• Degree if enlargement- 
  • The spleen enlarged diagonally from left hypochondrium to right iliac fossa
  • Measure the length from the dullness on percussion at the midclavicular line to the furthest extent of the spleen during expiration
• Splenic notch- feel the notch
• The margin of spleen- it is generally sharp
• Consistency
• Tenderness
• Smooth- smooth or rough
• Movement with respiration- Moves with respiration

Causes of Splenomegaly

Mild splenomegaly

• Malaria
• Acute leukaemia
• Chronic lymphatic leukaemia
• Hemolytic anaemia
• ITP
• Infectious mononucleosis
• Acute hepatitis
• Subacute bacterial endocarditis
• Portal hypertension

Massive splenomegaly

If the spleen measures more than 10 cm, it generally called massive

• Thalassemia major
• Chronic myeloid leukaemia
• Polycythemia Vera
• Myelofibrosis
• Storage disorders