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
- 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
- Smooth- smooth or rough
- Movement with respiration- Moves with respiration
Causes of Splenomegaly
- Acute leukaemia
- Chronic lymphatic leukaemia
- Hemolytic anaemia
- Infectious mononucleosis
- Acute hepatitis
- Subacute bacterial endocarditis
- Portal hypertension
If the spleen measures more then 10 cm, it generally called massive
- Thalassemia major
- Chronic myeloid leukaemia
- Polycythemia Vera
- Storage disorders