Splenomegaly is one of the four cardinal signs of hypersplenism which include. It is also enlarged with many liver infections, such as glandular fever. Subscribe to amboss youtube for the latest clinical examination videos, medical student interviews. 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. Spleen exam stanford medicine 25 stanford medicine. The spleen is not normally palpable except in slender young adults. Structure, function, and clinical disorders softcover reprint of hardcover 2nd ed. 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. It lies just beneath the left half of the diaphragm close to the 9th, 10th, and 11th ribs. An enlarged spleen is usually detected during a physical exam. Splenomegaly is often accompanied by hepatomegaly, as in blood disorders sickle cell, mediterranean anemia, leukemia, hodgkins and nonhodgkins lymphoma and lipid storage diseases gauchers and niemannpicks.
The inferior border separates the renal impression from the diaphragmatic surface and lies between the diaphragm and the upper part of the lateral border of the left kidney. Enlarged spleen splenomegaly diagnosis and treatment. The spleen is an organ found in virtually all vertebrates. The prevalence of these lesions has increased due to the increased number of immunosuppressed patients such as those with acquired immunodeficiency syndrome aids. Splenic rupture should therefore always be considered in blunt abdominal injuries ligaments. The spleen is an organ that lies behind the stomach on the left side of the abdomen.
The comments benign tumer of the spleen is hemangioma the comments tumer which cause spleenomegally is lymphoma congenital abnormalities of the spleen are 1 abscence of the spleen 2 splenunculi 3 hamartoma 4 splenic cyst the common cyst of the spleen is pseudocyst 4 times more than true cyst. The splenic artery penetrates the thick capsule which invests the organ fig 5. When the spleen can be felt below the left costal margin, at rest or on inspiration, splenic enlargement should be assumed and the. Your doctor can often feel it by gently examining your left upper abdomen. In sickle cell disease, the sickled red blood cells are not flexible and can be trapped. Pretest probabilities and likelihood ratios for clinical findings.
Clinical assessment begins with a thorough history and examination. The spleen usually lies in the left upper quadrant luq of the human abdomen. However, they are often absent and are not a reliable guide to the identification of the spleen during clinical examination. A palpable splenic edge always indicates splenomegaly, and a characteristic notch may be felt midway along its leading edge that helps in differentiating the spleen from the kidney. According to the shape or create, the spleen is classified into 3 types. A ruptured spleen is usually diagnosed based on the patients history and a physical examination.
An abdominal examination is a portion of the physical examination which a physician or nurse uses to clinically observe the abdomen of a patient for signs of disease. The spleen is enlarged in a number of important clinical diagnoses. The physical examination should include palpation with the patient in the supine and right lateral decubitus position, with knees up and hips flexed. 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. As i prepare to present my diagnosis of hepatitis cassociated lymphoma at the clinical pathology conference, i focus on one of the key findingssplenomegalyobserved on exam and ct scan. Enlarged spleen detected by abdominal ultrasonography in. Evaluation of splenomegaly and other splenic disorders in.
It ranges in length from 6 to cm and in weight from 75 to 120 g. The spleen also clears bacteria and is important for proper immune function, especially in fighting bacteria. The spleen in located in the upper left quadrant of the abdomen, under cover of the diaphragm and the ribcage and therefore cannot normally be palpated on clinical examination except when enlarged. Apply light fingertip pressure as the patient slowly inspires. Splenectomized patients should receive a prophylactic vaccination against pathogens that frequently cause sepsis, such as streptococcus pneumoniae, h. Rheumatoid arthritis ra is a systemic, chronic inflammatory disease of unknown cause. Prevalence and clinical significance of splenomegaly in. The abdominal examination is conventionally split into. 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 practice. The spleen is subject to trauma, particularly from overlying fractured ribs. Everyday low prices and free delivery on eligible orders. This much enriched understanding encompasses the spleens complex role in immunological defense, the recently.
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%. The best sleeping position for back pain, neck pain, and sciatica tips from a physical therapist duration. I wonder if suspicion for splenomegaly played a role in the decision to examine the spleen and which technique was used. Full text of clinical examination a systematic guide talley, nicholas j see other formats. Saul rosenberg is a stanford university emeritus professor and a luminary in the research and treatment of hodgkins disease and other lymphomas. The long axis lies along the shaft of the 10th rib, and extends forward only as far as the midaxillary. The spleen can be affected by numerous medical conditions.
Similar in structure to a large lymph node, it acts primarily as a blood filter. In any abdominal examination it is important to assess for groin hernias. Spleen disorders ask hematologist understand hematology. Patients who are homozygous for hgbs usually have small sequential splenic infarcts as a result of microvascular occlusion and the spleen usually becomes small, fibrotic, and dysfunctional by the age of 5 years. Palpation and percussion of the spleen are important techniques for identifying an enlarged spleen. Your doctor may confirm the diagnosis of an enlarged spleen with one or. 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. The spleen also makes certain substances that have an important role in inflammation and healing. He is also a skilled bedside examiner and has wonderful tips for examining the spleen and lymph nodes. Clinical events were recorded prospectively for 1 year after the examination to evaluate the clinical importance of splenomegaly. Abdominal examination detailed oxford medical education. Ruptured spleen diagnosis and tests cleveland clinic.
Spleen knowledge for medical students and physicians. Examination of the spleen clinical examination youtube. Examination of the spleen percussion of the spleen consult the expert dr. The examination may be facilitated by gently lifting the left flank of the patient ventrally. The spleen is a wedgeshaped soft organ with purple colour. Pmc free article halpern s, coel m, ashburn w, alazraki n, littenberg r, hurwitz s, green j. It is an intraperitoneal organ, entirely surrounded by peritoneum except at the splenic hilum. Clinical examination of spleen linkedin slideshare. The size of the spleen nearly corresponds to the fist of the subject.
The splenic ligaments connect the spleen to neighboring structures, contain important vessels and are part of the. The normal adult spleen lies immediately under the diaphragm in the left upper quadrant of the abdomen. The use of the reverse trendelenburg position may aid in bringing the spleen into contact with the examiners fingers. History may elicit symptoms of pressure effects from the enlarged spleen e. When the spleen can be felt below the left costal margin, at rest or on inspiration, splenic enlargement should be assumed and the explanation sought. The physical examination typically occurs after a thorough medical history is taken, that is, after the physician asks the patient the course of their symptoms. See causes of splenomegaly, evaluation of clinical utility of palpating the spleen. Full text of clinical examination a systematic guide. 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. The purpose of both palpation and percussion of the spleen is to look for splenic enlargement. However, in some people especially those who are slender a healthy, normalsized spleen can sometimes be felt during an exam. Of the 70 patients in our cohort, 50 71% were male and 20 were female. It may be appropriate at this point to examine the external genitalia but this is a test usually offered at the end of the examination. Unlimited access to the largest elibrary of professional videos, images, documents, courses.
Often, if the patient is stable, an ultrasound or ct scan will be performed. Determinations by nuclear medicine studies and physical examination. 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. Clinical symptoms are directly dependent upon the amount of hgbs present, and this is variable. We teach and promote bedside exam skills to students, residents and healthcare professionals both in person and online.
Spleen is located in left upper part of abdomen or hypochondrium. A primer on the precision and accuracy of the clinical examination table. Approximately 510% of patients with ra have an enlarged spleen on manual palpation1 or on isotope scanning. It removes old red blood cells and holds a reserve of blood, which can be valuable in case of. 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. Mr imaging shows the abscess as a lesion of fluid signal. The study described here suggests that the novel spleendedicated fibroscan examination performs better than the standard fibroscan for the detection of large evs area under the curve 0. Reliability of clinical techniques for detecting splenic enlargement. 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. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Moreover, the examination should start with traube space percussion, followed, if dull, by supine 1handed palpation. Infections and injuries can damage your spleen and cause it.
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