GI 4 - Examine the spleen Flashcards
Explains procedure to patient, positions and drapes (re-drapes as needed).
“Today I am going to be performing an examination of your spleen. This will involve me looking at and touching your tummy area. If at any area you feel uncomfortable or experience pain, please let me know?”
Inspects and comments on systemic manifestation of splenic disease: pallor, conjunctival pallor, etc.
“Upon inspecting the face and mouth I do not note any paleness of the skin and the mouth mucosa is moist and pink. This indicates that there are no systemic manifestations of splenic disease, such as anemia.”
Inspects the abdomen and comments on symmetry,
“I’m going to begin by observing the general appearance of my patient lying quietly. (Standing on the right of the patient; you should be bending down so that you can view the abdomen tangentially)
I will be inspecting the surface contours, and movements of my patient’s abdomen, looking for bulges or peristalsis. My patient’s abdomen appears* (say what you see- symmetric, flat, rounded, protuberant, or scaphoid-markedly concave or hollow).*
There is no visible peristalsis (normally peristalsis is visible in very thin people). Visible peristalsis could suggest intestinal obstruction. (Color) I’m noting no bruises, erythema, or jaundice. No scars are visible which could be due to any trauma or past surgeries. I’m noting no striae (stretch marks).
Abnormally colored striae (pink-purple) are a hallmark of Cushing syndrome. I’m also noting no signs of engorged veins (a few small veins may be visible normally). Visibly engorged veins could suggest portal hypertension from cirrhosis (caput medusa) or inferior vena cava obstruction.
Also, the umbilicus doesn’t appear everted. An everted umbilicus suggests a ventral hernia. There appears to be no bulging of the flanks* (full flanks are present).* If bulging of the flanks were present this could suggest ascites.”
Palpates lower border of spleen– starts in RIF, asks Pt to inhale deeply, bimanual, roll patient to right
“Can you please bend your knees?” (Done to relax muscles)
“I’m going to reach over my patient placing my left hand under their back supporting/pressing the lower left rib cage forward. With my right hand below the left costal margin, I’m going to press in toward the spleen.”
“Can you please take a deep breath?” (Roll patient to the right)
“I am not able to palpate the spleen. If the spleen was palpable this could be indicative of COPD, or splenomegaly.”
Patients suffering from renal stone (colicky pain) move around frequently to find a comfortable position.
Demonstrates splenic percussion sign and Traube’s space resonance and comments on findings
“Next, I’m going to percuss the spleen in Traube’s space which is located between the 6th and 10th intercostal space, to see if there are any signs of splenomegaly. Since the spleen enlarges from left costal margin down and medially towards the right iliac fossa, to percuss the spleen* (situated on the left side superior to the stomach)* LUQ, I will begin percussion in the right iliac fossa and proceed diagonally in straight line toward the left costal margin. Can you please breathe in deeply?” (This will detach the spleen edge downward against fingertips).
“Upon percussion in Traub’s space, tympany was heard. If dullness was heard, this would indicate splenomegaly.”
Spleen is lateral to and behind the stomach, just above the left kidney in the left midaxillary line. Its upper margin rests against the dome of the diaphragm. The 9, 10, 11th ribs protects the spleen. Tip of the spleen is palpable below left costal margin in some people, but it is palpable in splenomegaly.
Normal adult spleen lies under the diaphragm in the left upper quadrant of abdomen. It is not normally palpable and felt when size is increased threefold.
Traube’s space is the tympanic stomach gas below the costal ribs. It extends from rib 6* (parallel line)* midclavicular and rib 9 (anterior axillary) parallel line forming an equilateral shape. Within the shape, you can differentiate the dullness of the cardiac viscera and tympanic stomach bubble
List at least three ways to differentiate an enlarged spleen from an enlarged kidney
“There are several ways to differentiate an enlarged spleen from an enlarged kidney.** First**, the notch on the anterior border would be palpable in a spleen, but not the kidney. Secondly, splenic rub would be present on auscultation when the patient breaths in and out. Thirdly, the spleen enlarges diagonally towards the right lower quadrant, while the kidney enlarges inferiorly.”
