From the Guidelines
To palpate the spleen, have the patient lie supine with knees slightly flexed to relax the abdominal muscles, and use a gentle technique to avoid rupture, as an enlarged spleen can be detected by feeling a mass or edge below the left costal margin during inspiration 1. The technique involves standing on the patient's right side and placing your left hand under the patient's lower left rib cage, supporting and slightly elevating the area.
- Use your right hand to palpate, starting at the right lower quadrant and moving diagonally toward the left costal margin.
- Ask the patient to take a deep breath as you press inward and upward with your fingertips. This maneuver helps bring the spleen downward toward your examining hand during inspiration.
- A normal spleen is usually not palpable.
- If you feel a mass or edge below the left costal margin during inspiration, this suggests splenic enlargement. The spleen moves with respiration and has a characteristic notch on its medial border.
- Percussion tenderness over the lowest left intercostal spaces (Traube's space) may indicate splenic enlargement even when the organ isn't palpable. This technique is important for detecting splenomegaly, which can indicate infections, hematologic disorders, portal hypertension, or other systemic conditions, and is supported by guidelines for physical examination in patients with lymphoma 1.
From the Research
Palpation of the Spleen
To palpate the spleen, it is essential to understand its anatomy and location. However, the provided studies do not directly address the technique of palpating the spleen.
Anatomy and Function
- The spleen is the largest secondary immune organ in the body, responsible for initiating immune reactions to blood-borne antigens and filtering the blood of foreign material and old or damaged red blood cells 2.
- The spleen has two main compartments: the white pulp and the red pulp, which are vastly different in their architecture, vascular organization, and cellular composition 2.
- The unique architecture of the spleen allows for interactions between the circulatory, reticuloendothelial, and immune systems, enabling it to maintain the integrity of the blood and respond to circulating antigens 3.
Clinical Significance
- The spleen plays a central role in regulating the immune system, and its function is crucial in responding to blood-borne pathogens 4.
- The spleen is also involved in metabolic and endocrine functions, particularly in relation to nonalcoholic fatty liver disease 5.
Limitations
There are no research papers among the provided studies that directly assist in answering the question of how to palpate the spleen. The studies primarily focus on the anatomy, function, and clinical significance of the spleen, rather than providing guidance on palpation techniques.