Although several methods of palpation and percussion of the spleen have been described, until recently they have not been validated by noninvasive imaging techniques such as ultrasonography, radionuclide scanning, and computed tomography that offer objective means to assess splenomegaly. Persons with an enlarged spleen often exhibit other signs and symptoms associated with the underlying cause of the enlargement, such as liver disease, an infection or a blood disorder 9. Reliability of clinical techniques for detecting splenic. Clinical examination of the lymph nodes includes inspection and palpation of all clinically relevant major lymph node groups. With malignant splenic tumor being much more common than benign lesions, most of the patients undergo splenectomy 2. As it lies deep within the rib cage, the spleen is generally not palpable except in particularly slender individuals or if it is pathologically enlarged splenomegaly. Clinical examination of the hemodynamically unstable.
It serves as a graveyard for old or flawed red blood cells oxygencarrying cells and as a storage site for blood and platelets essential for clotting. There are detailed ct scan images demonstrating different splenic disorders and excellent illustrations of the different surgical techniques on the spleen. Feb 14, 2017 clinical examination splenomegaly percussion percussion from rif towards lhc like single handed palpation percussion of traubes semilunarspace crescentshaped space, encompassed by the lower edge of the left lung, the anterior border of the spleen, the left costal margin and the inferior margin of the left lobe of the liver. A perfunctory examination while assuming the spleen is not going to be palpable is the best way to miss an enlarged spleen. The spleen is located in the left cranial abdomen and usually follows the greater curvature of the stomach in the dog. The spleen is an intraperitoneal organ located in the left upper quadrant of the abdomen that originates from the mesoderm. With your left hand, reach over and around the patient to support and press forward the lower left rib cage and adjacent soft tissue. In part this is because the spleen enlarges in the inferior anteromedial direction, sometimes as far as the rlq.
Wandering spleen is a rare condition in which the spleen is excessively mobile and migrates from its. On physical examination, a doctor can usually feel a significantly enlarged spleen. There are detailed ct scan images demonstrating different splenic disorders and excellent illustrations of the. Deeper palpation of the abdominal organs liver, spleen, kidneys, aorta and abdominal cavity may detect enlargement or abnormal masses. The spleen also clears bacteria and is important for proper immune function, especially in fighting bacteria. The spleen is where the blood is stored when its not needed. The normal palpable spleen is soft, smooth, and non tender and is less than 1 to 2 cm below the left costal margin. Moreover, the examination should start with traube space percussion, followed, if dull, by supine 1handed palpation. A systematic guide to physical diagnosis, 7th edition breaks down each body system into a logical framework focusing on the history, clinical examination and correlation between physical signs and disease for each system. If an enlarged spleen is already suspected, palpation should begin further down. The spleen is a fist sized organ located in the left upper quadrant of the abdomen. A spleen easily palpable below the costal margin in any child over the age of 34 years should be considered abnormal until proven otherwise. The november 2330, 2005, issue of jama includes an article about children who sustain an injury to the spleen. Jul 08, 2019 in gaucher or niemannpick disease, splenomegaly is often the first clinical manifestation.
The spleen must take in and process all that information, including the food we eat and liquids we drink, so you can imagine, it is a very hard working organ. Clinical and pathologic characteristics of ten cases. Helping students to navigate from first impressions through to the end of consultation, the text. Each of the four physical examining techniquesinspection, auscultation, palpation, and percussionis important in examining for splenic enlargement. Castells sign is a medical sign assessed to evaluate splenomegaly and typically part of an abdominal examination. Clinical examination a systematic guide to physical. Overview of the spleen blood disorders merck manuals. Clinical examination splenomegaly percussion percussion from rif towards lhc like single handed palpation percussion of traubes semilunarspace crescentshaped space, encompassed by the lower edge of the left lung, the anterior border of the spleen, the left costal margin and the inferior margin of the left lobe of the liver. Examination of the lymph nodes clinical examination youtube. Hemangioma of the spleen jama internal medicine jama. The splenic ligaments connect the spleen to neighboring structures, contain important vessels and are part of the greater omentum.
Oct 26, 2016 clinical examination of the lymph nodes includes inspection and palpation of all clinically relevant major lymph node groups. National institute for health and clinical excellence technology appraisals. Jan 09, 2018 the physical examination should include palpation with the patient in the supine and right lateral decubitus position, with knees up and hips flexed. In this thoroughly revised and updated second edition, a panel of distinguished clinical researchers from around the world takes stock of the wealth of new knowledge about the human spleen and applies it to the pathology and treatment of splenic diseases. This much enriched understanding encompasses the spleens complex role in immunological defense, the recently defined function of. The complete spleen structure, function, and clinical disorders. Gastrointestinal examination and questions for doctors, medical student exams, finals, osces and mrcp paces. Clinical assessment of the patient with kidney disease. Something that you can do to give your spleen a break, is to literally, take a break. Although there are few publications and it remains controversial, its value considered as limited by 50% of medical practicioners 1.
James garden, mbchb md frcsed frcped fracshon, is the regius professor of clinical surgery at the department of clinical and surgical sciences at the university of edinburgh and royal infirmary of edinburgh in the uk. The detection of an enlarged spleen is important in clinical diagnosis but seems to be subject to considerable inaccuracies. Dull to percussion in cases of splenomegaly if hollow sound then rulesout diagnosis. The goal of this stanford medicine 25 session is for you to be able to list these signs from head to foot. Examination of the gallbladder and liver osce wikiversity. If there is a tear or some other damage to the spleen, it can and usually is removed. Clinically relevant lymph nodes are located in the head and neck, the. Structure, function, and clinical disorders under the title of. Verhaert, in medical history and physical examination in companion animals second. The use of the reverse trendelenburg position may aid in bringing the spleen into contact with the examiners fingers. As the spleen is under the left hypochondrium and lung base, us examination can be difficult, particularly looking at the deep pole. In this video you can see examination of the spleen.
It plays a modest haematopoietic role in the middle part of fetal life, but in the adult haematopoiesis is usually only seen in pathological states. These maneuvers have received more extensive evaluation than other maneuvers, allowing us greater confidence in the findings. Near the anterior extremity there may be one or two notches that have persisted from the lobulated form of the spleen in early fetal life. Some people may need removal of the spleen to prevent deadly bleeding that can occur after an injury, to treat diseases that cause disruption of blood cells, or to treat cancers involving the spleen. Primary tumors of the spleen are rare and with the exception of malignant lymphoma are seldom considered in the differential diagnosis of splenomegaly. A primer on the precision and accuracy of the clinical examination. The spleen and some of its diseases provides information pertinent to the fundamental aspects of the spleen. Additionally, rib shadowing may reduce organ visibility. An enlarged spleen may be missed if the examiner starts too high in the abdomen to feel the lower edge. Splenic rupture should therefore always be considered in blunt abdominal injuries ligaments. The contact with the patient creats the relations of confidence which is the fundament of medical ethics.
We report a case of ipt of spleen diagnosed postoperatively on histopathological examination of resected spleen in a 41year old lady suspected to have splenic tumor on abdominal imaging. Orlando catalano, in clinical ultrasound third edition, 2011. Clinical examination a systematic guide to physical diagnosis. The spleen is an organ that lies behind the stomach on the left side of the abdomen. Spleen palpation physical examination click to cure cancer. Examination of the spleen clinical examination youtube. It is an alternative physical examination maneuver to percussion over. Evaluation of splenomegaly is notoriously difficult and embarrassingly easy to miss when present.
An average adult spleen weighs about 150 g and it has to become enlarged to at least three times its normal size before becoming palpable on clinical examination p. The spleen has only a thin capsule and is a wellvascularized organ, making it susceptible to injury and rupture, especially through trauma to the luq or left lower ribs. Examination of the gallbladder and liver osce from wikiversity. Assessing for the presence of splenomegaly is an important component of the physical examination. The exact position of the spleen is variable, depending on the amount of gastric distention and the size of other abdominal organs. Examination of the spleen the spleen is enlarged in a number of important clinical diagnoses. In cases in which splenomegaly is questioned, the clinical examination is more specific than sensitive and is best used when ruling in the diagnosis among patients for whom the suspicion is at least 10%. Appropriate limitation of activity, including avoiding contact sports, will help prevent trauma that might cause the spleen to rupture.
Clinical examination techniques were championed by the sage clinician with the most experience. Dec 06, 2019 clinical examination accounts as a fundamental part in the management of most critical scenarios. The spleen is the largest collection of lymphoid tissue in the body. The complete spleen structure, function, and clinical. Apply light fingertip pressure as the patient slowly inspires. Pneumonia parkinson disease peripheral arterial insufficiency pneumonia examination precordial exam stds spleen swollen leg exam thyroid exam upper vs lower motor neuron. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. The physical examination should include palpation with the patient in the supine and right lateral decubitus position, with knees up and hips flexed.
Try to feel the tip or edge of the spleen as it comes down to meet your fingertips. With your right hand below the left costal margin, press in toward the spleen. Pretest probabilities and likelihood ratios for clinical findings. This book is edited by a team of experts from across the globe. Splenomegaly is one of the four cardinal signs of hypersplenism which include. Clinical examination of the hemodynamically unstable patient.
Spleen exam stanford medicine 25 stanford medicine. Castells point percussion best negative likelihood ratio percuss point at midaxillary line at last intercostal space. The clinical significance of the spleen springerlink. Fully updated with the latest clinical data, including specially commissioned research, clinical examination addresses the core principles and clinical skills that underpin diagnosis for safe, effective medical. After trauma, palpable subcapsular hematomas may develop in the spleen, which may eventually develop into clinically palpable pseudocysts.
Anatomy develops from condensations of mesoderm in the dorsal mesogastrium. Harris nl, aisenberg ac, myer je, ellman l, elman a 1984 diffuse large cell histo cytic lymphoma of the spleen. In a small percentage of normal adults, the tip of the spleen is palpable. Spleen knowledge for medical students and physicians. Lymphatic system clinical examination of the lymphatic system spleen clinical examination of the lymphatic system clinical examination of farm animals wiley online library. The abdominal examination teachmesurgeryteachmesurgery. The spleen is enlarged in a number of important clinical diagnoses. Stanford medicine 25 teaches and promotes bedside medicine exam skills to students, residents and healthcare professionals both in person and online. Splenomegaly american academy of pediatrics textbook of. The contact with the patient creats the relations of confidence which is. Full text of clinical examination a systematic guide talley. Examination of the lymph nodes clinical examination. Splenomegaly is the result of the accumulation of abnormal lipids in splenic macrophages. The purpose of both palpation and percussion of the spleen is to look for splenic enlargement.
Unlimited access to the largest elibrary of professional videos, images, documents, courses. Dec 04, 2016 the spleen is where the blood is stored when its not needed. Abdominal examination an overview sciencedirect topics. Such tumors may be either cystic or solid, and the cystic variety, composed mostly of epidermoid cysts, has occurred with slightly greater. When emergency physicians classify a patient as unlikely to have an abdominal injury based on their overall impression, the patient is less likely to have suffered an injury lr 0. Full text of clinical examination a systematic guide talley, nicholas j see other formats. Clinical examination of the lymphatic system clinical. Note any tenderness, assess the splenic contour, and measure the distance between the spleen s lowest point and the left costal margin. Abdominal examination detailed oxford medical education. In the clinical aspects of the disorders of the spleen, there is a well thought out sequence of discussions about the various disorders and their. Examination of the liver liver exam stanford medicine 25. The approach to this part of the physical examination should be to operate on the hypothesis that the spleen is enlarged and only be convinced that this is incorrect if your best attempts to confirm the hypothesis fail. The spleen has a unique location, embryological development and histological structure that differs significantly from other lymphoid organs special histological features define several important functions of the spleen. Clinical significance the presence of an enlarged spleen can frequently be the clue that puts the other physical findings in perspective and leads to the correct diagnosis.
However, you do not necessarily have to have the spleen to survive. Examination of the gastrointestinal system detailed. This book discusses the role that spleen plays in the etiology of diseases whose most obvious symptoms are evoked by associated or consecutive affections of other organs. Clinical examination accounts as a fundamental part in the management of most critical scenarios. Click here for the professional version click here for the professional version the spleen, a spongy, soft organ about as big as a persons fist, is located in the upper left part of the abdomen, just under the rib cage. The role of the spleen in human disease has been slow to emerge from the shadow of galen s aphorism describing the spleen as an organ full of mystery. In gaucher or niemannpick disease, splenomegaly is often the first clinical manifestation. It is normally palpable in preterm infants, in 30% of normal, fullterm neonates, and in 5% to 10% of infants and toddlers. Bland, md, is based at the university of alabama school of medicine, birmingham, al, in the usa, where he is the fay fletcher kerner professor and chairman of the department of surgery, and the deputy director at the comprehensive cancer center. Palpation and percussion of the spleen are important techniques for identifying an enlarged. A bestselling title for over 25 years, the updated seventh edition of talley and oconnors clinical examination is an essential read for all student clinicians. The spleen usually lies in the left upper quadrant luq of the human abdomen. Oct 01, 2019 clinical examination is the most important step in diagnostics and treatment of patients.
Clinical examination is the most important step in diagnostics and treatment of patients. Structure, function, and clinical disorders under the title of the spleen in 1990, there has appeared a wealth of new information that now demands incorporation into the diagnosis and management of patients with splenic disorders. The presence of an enlarged spleen should lead to examination of the peripheral blood by the physician. It is the largest lymphoid organ and thus the largest filter of blood in the human body. The physician will also ask a series of questions to determine if there are symptoms either from the enlarged spleen or the underlying cause of the large spleen. Full text of clinical examination a systematic guide. The results of palpation and percussion techniques for detecting. However, they are often absent and are not a reliable guide to the identification of the spleen during clinical examination. The examination may be facilitated by gently lifting the left flank.