PHYSICAL EXAMINATION
OF THE SPLEEN
EXAMINATION OF THE SPLEEN
• PERCUSSION
COMPLIMENTARY
• PALPATION
• INSPECTION?
• AUSCULTATION?
THE SPLEEN
10TH 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.