1. PHYSICAL EXAMINATION OF THE SPLEEN

2. EXAMINATION OF THE SPLEEN
PERCUSSION
PALPATION
INSPECTION?
AUSCULTATION?
COMPLIMENTARY

3. THE SPLEEN
10TH RIB
SPLEEN

4. 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.
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
NIXON’S METHOD – PERCUSS MIDWAY ALONG LEFT COSTAL MARGIN. NORMALLY DULLNESS DOES NOT EXTEND FURTHER THAN 8 CM ABOVE THE COSTAL MARGIN.

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

6. 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

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

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

9. 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.