PHYSICAL EXAMINATION OF THE SPLEEN EXAMINATION OF THE

PHYSICAL EXAMINATION OF THE SPLEEN

EXAMINATION OF THE SPLEEN • PERCUSSION COMPLIMENTARY • PALPATION • INSPECTION? • AUSCULTATION?

THE SPLEEN 10 TH RIB SPLEEN

EXAMINATION OF THE SPLEEN PERCUSSION OF TRAUBE’S SPACE – SIXTH RIB SUPERIORLY, MIDAXILLARY LINE LATERALLY AND LEFT COSTAL MARGIN INFERIORLY. NORMALLY THE PERCUSSION NOTE IS RESONANT. DULLNESS IMPLIES SPLENOMEGALY. NIXON’S METHOD CASTELL’S METHOD – PERCUSS IN THE LOWEST INTERCOSTAL SPACE IN THE LEFT MIDAXILLARY LINE IN BOTH EXPIRATION AND FULL INSPIRATION. NORMALLY THE PERCUSSION NOTE IS RESONANT. DULLNESS IMPLIES SPLENOMEGALY. NIXON’S METHOD – PERCUSS MIDWAY ALONG LEFT COSTAL MARGIN. NORMALLY DULLNESS DOES NOT EXTEND FURTHER THAN 8 CM ABOVE THE COSTAL MARGIN.

EXAMINATION OF THE SPLEEN - PALPATION BIMANUAL PALPATION SUPINE DEEP BREATH FLEX KNEES AND HIPS RIGHT LATERAL DECUBITUS POSITION BALLOTTEMENT PALPATION FROM ABOVE - HOOKING

ARE ENLARGED SPLEENS EVER NORMAL? • 3% OF HEALTHY COLLEGE STUDENTS • 12% OF NORMAL WOMEN POSTPARTUM • 2. 3 – 3. 8% OF PATIENTS IN AN OFFICE PRACTICE

COMMON ETIOLOGIES OF SPLENOMEGALY • PORTAL HYPERTENSION • HEMATOLOGIC MALIGNANCY LYMPHOMA, LEUKEMIA • INFECTIOUS DISEASE HIV, MONONUCLEOSIS, MALARIA • SPLENIC HEMATOMA

KEHR’S SIGN REFERRED PAIN TO THE LEFT SHOULDER AS A CONSEQUENCE OF AN IRRITATED LEFT HEMIDIAPHRAGM. MAY BE DUE TO SPLENIC RUPTURE.

SUMMARY • PERCUSS FIRST AND IF POSITIVE THEN PALPATE. • KNOW THE DIFFERENTIAL DIAGNOSIS OF SPLENOMEGALY. • KNOW THE PITFALLS. • IF YOUR CLINICAL SUSPICION REMAINS HIGH AFTER CLINICAL EXAMINATION PROCEED WITH A RADIOGRAPHIC STUDY.