Spleen examination

Palpating the spleen

There are many ways to palpate the spleen.

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 at 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

Massive splenomegaly

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