23. Physical methods of examination of the spleen. Splenomegaly

Covers the physical examination of the spleen, beginning with when it becomes palpable and the patient positions used. It then walks through inspection, the bimanual palpation technique with the features to note, and percussion using Traube's space and Castell's sign. Auscultation and a five-grade scale for splenomegaly, from non-palpable to beyond the umbilicus, close the note.

Inside: 7 sections · 3 labelled pictures · 3 tables · 15 flashcards · 2 min

Topic 22 of 30 in the MU Sofia syllabus for Internal Medicine (Practical) (Medicine, Year 3). The free AceMed note covers it in 7 sections, about 192 words (2 min of reading), with 15 flashcards.

I. General Considerations

The spleen is not normally palpable in healthy individuals.
It must be enlarged 2–3 times its normal size to become palpable.
Examination is performed with the patient in supine or right lateral decubitus position.

II. Inspection

Often unremarkable unless massive splenomegaly.
May observe:
Left-sided abdominal fullness or bulge
Skin changes (rare)
Signs of underlying disease: pallor (anemia), petechiae (hypersplenism), jaundice (hemolysis)

III. Palpation of the Spleen

Method:

1. Patient supine, knees flexed to relax abdominal wall.

2. Start palpation in right iliac fossa and move diagonally toward the left hypochondrium.
3. Use two hands: left hand under the left lower ribs to lift the spleen forward, right hand palpates anteriorly.
4. Ask patient to inhale deeply — spleen moves downward.

Features to Observe if Palpable:

NOTE: Differentiates spleen from kidney (which does not move with respiration and has no notch).

IV. Percussion of the Spleen

A. Traube’s Space Percussion:

Located in left lower anterior chest wall.
Normal: tympanic
Dullness: suggests splenomegaly, left pleural effusion, or stomach fullness.

B. Castell’s Sign:

Percuss 8th or 9th intercostal space on anterior axillary line.
Tympanic → Normal
Dullness on inspiration → Splenomegaly