Examination of the Spleen (Stanford Medicine 25)
15
October

By Paul Henry / in , , , , , , , , , , , , , /


in examining the spleen unlike the liver the screen I think is a tricky organ to perk us the liver tends to come down flush with the costal margin like this whereas the spleen comes away from the costal margin doesn’t usually have a distinct edge and is generally softer and less distinct than the liver and therefore I think technique is very important in examining the spleen the spleen enlarges in this direction towards the right lower quadrant that it’s very embarrassing to miss a spleen because you started so high so I would suggest starting over here in the right lower quadrant and working your way up the most important dictum though in examining the spleen is to let the spleen palpate your fingers and not the other way around so once you get your hands set have the patient take a deep breath would you take a deep breath and when he breathes out I take up my next position deep breath out and this way if the spleen is there and your fingers are not moving you have a good chance of it coming and brushing your fingers I always think it’s hard if you’re moving like this and the spleen is moving it’s very unlikely that these two ships will cross in the night very often people are instructed to pull up on the rib cage like so I don’t really understand the utility of that I don’t think it really helps my suggestion is begin in the right lower quadrant once you get your fingers in position have the patient’s diaphragm do the work for you let the spleen palpate your fingers and not the other way around don’t dig because there is no gold having said that dr. Rosenberg here and eminent oncologists with lots of experience with Hodgkins teachers also that if the spleen is not palpable you can actually dig your hand in there have the patient take a deep breath and in some patients especially women he feels you can feel this panic tip even though it may not be appreciable by any other method percussion of the spleen is not exact it’s not a it’s not something that you can absolutely rely on it might give you a hint that the spleen is enlarged the way to perk us is to follow the anterior axillary line down to the last intercostal space and that last intercostal space should normally be tympanic or tympanic because that’s draw up space and when the patient takes a deep breath if it becomes dull it suggests that spring might be enlarged and you can hear a changing note a little bit there the preceding program is copyrighted by the Board of Trustees of the Leland Stanford junior University please visit us at med.stanford.edu


34 thoughts on “Examination of the Spleen (Stanford Medicine 25)

  1. please help me, i have had pain on my left side just at the bottom of my rip cage for 2 months now, and diarrhea for the last month, The test i have had are,stool sample, pap smear and a scan on my kidneys, blood tests and they are all negative.but the pain wont go and the diarrhea and i,m down to drinking fluids and ice blocks,

  2. I feel something on the left side when you lean forward, as if moving, but when I go to bed not feeling se.Da you so palpable spleen

  3. For about 8 years now, I have had a slight bulge from under my bottom left rib cage, that never hurt me nor caused me any issues. It is under the skin, so I thought it may be a benign cyst or perhaps even a hernia. Recently, however, I have suspected it was my spleen perhaps enlarged, but after watching this video, the location that the doctor is examining is not the same location as mine. Mine is far more on my side, even a little toward my back. Any idea if this could still be my spleen? It's more of a vertical/sideways bulge, not round at all. It's firm, but not like a rock. I never really felt like it was critical, since it never gave me any issues through the years.

  4. thanks for your videos…it helped a lot to me like a medical student to prepeare my exams…Best wishies!

  5. please help me my brother … i love him so much ..i adore him he is 12 years old and he had for 6 years epilepsy drug he stopped taken them for 1 and a half year now he have a simple enlarfed spleed whats treatment

  6. CORRECTION: U said Anterior Axiallary Line…but it seems to be me mid clavicular line in the video during spleen percussion ….Am I right?

  7. Per your comment on pulling on the ribcage, my school taught us to have the patient to roll to their right side, then we support their left side by holding at their ribcage. By being on their R side, the left-sided spleen will hang down a bit more freely and possibly be more palpable if enlarged. I'm only learning it, so I still don't know how practical it is in practice. Thanks for the video!

  8. Can an enlarged spleen or any other organ cause uneven rib cage? I noticed a few months ago that my left rib cage sticks out a bit more than my right. I also have swollen lymph nodes so I was wondering if they were related, perhaps mono or something, even though I've only really had drainage, cough, sore throat, and ear ache, or maybe it's just a coincidence that I have so many different things going on at once. I tried feeling for the spleen myself but am not sure what it would feel like and cannot find anything that stands out. Thanks.

  9. "Those two ships won't be crossing in the night"
    "Don't have to dig, there is no gold"

    LOL this doctor. I like it.

  10. what the feature of the spleen differentiate it from other intra-abdominal organs and masses during palpation of the abdomen?

  11. What i've learned is that, if i don't find a spleen then it's all good. A palpable spleen is a pathological one.

Leave a Reply

Your email address will not be published. Required fields are marked *