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 abdomen.
  • Percuss the left axilla on the midaxillary line from left axilla downwards.
  • You should feel it dull a the 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 then 10 cm, it generally called massive

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

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