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The commonest cause of splenomegaly in the western world will be a viral infections, such as mononucleosis
Overview of Spleen Examination
The spleen examination is performed to assess the size and consistency of the spleen. It is a critical part of the abdominal examination, especially in cases of suspected splenomegaly or other hematological conditions.
Preparation
- Ensure privacy and obtain consent from the patient.
- Explain the procedure to the patient and answer any questions they may have.
- Ensure the patient is comfortably positioned, typically lying supine with their arms at their sides.
Inspection
- With the patient lying flat, observe the abdomen for any visible masses or distention.
- Ask the patient to take a deep breath and observe for any changes in the contour of the abdomen, particularly in the left upper quadrant.
Palpation
- Stand on the right side of the patient.
- Begin palpation from the right iliac fossa and move diagonally towards the left costal margin.
- Ask the patient to take a deep breath in, and with each breath, advance your hands closer to the left upper quadrant.
- Palpate gently but firmly, feeling for the spleen as it may descend with inspiration.
- If the spleen is not palpable, repeat the process with the patient turned to their right side (right lateral decubitus position), which can make the spleen more accessible.
- Support the patient’s back with your left hand and palpate with your right hand.
Percussion
- Percuss from the left lower ribcage (Traube's space) towards the midline to detect any dullness that may indicate splenomegaly.
- Normal spleen size does not usually extend below the costal margin, so dullness below this line can suggest an enlarged spleen.
Common Findings
- Normal:
- The spleen is not usually palpable in healthy individuals.
- Percussion of Traube's space is typically resonant.
- Abnormal:
- Splenomegaly: The spleen is palpable below the costal margin, indicating enlargement.
- Consistency: A firm spleen may suggest conditions such as chronic leukaemia, while a soft, tender spleen may indicate acute infections or congestion.
- Percussion: Dullness in Traube's space suggests splenomegaly.
Documentation
- Record your findings in the patient's medical record, including:
- Presence or absence of splenomegaly.
- Consistency, tenderness, and size of the spleen if palpable.
- Any associated findings, such as liver enlargement or abdominal masses.
Patient Education
- Explain the significance of your findings to the patient in understandable terms.
- Discuss any further investigations or referrals that may be needed based on your findings.
- Advise on any specific symptoms to watch for and when to seek further medical attention.
Summary
A thorough spleen examination involves careful inspection, palpation, and percussion to assess for splenomegaly or other abnormalities. Accurate documentation and patient education are crucial for effective diagnosis and management.