Spleen Exam (OSCE)
Patient positioning edit
- knees flexed
- expose from nipples to pubis
Spleen location edit
- posterior to the midaxillary line (MAL), between 9 to 11th ribs, size of palm
General edit
Peripheral signs of hypersplenism edit
- pallor
- bruising
- oral ulcers
- skin infections
- petechiae
Stigmata of diseases associated with splenomegaly edit
- hepatomegaly
- lymphadenopathy (CLL, lymphoma, EBV)
- jaundice (hemolytic anemia)
- macroglossia (amyloidosis)
Inspection edit
*from the FOOT OF THE BED
Static edit
- Skin
- surgical scars
- discoloration
- Contour
- distended
- obese
- umbilical herniation
- bulging flanks
With Deep Inspiration edit
- Symmetry - during several deep inspirations
- note that the spleen enlarges toward the RLQ
Percussion edit
Traube’s Space edit
- 6th rib, lower costal margin, MAL
- tympanic due to the gastric bubble - in splenomegaly, stomach is displaced and region sounds dull (not a specific test)
- False Positives: full stomach, pleural effusion and pneumonia
Castell’s sign edit
- lowest intercostal space, L AAL
- ask the patient inhale and exhale slowly and deeply
- splenomegaly → resonant on expiration but dull on inspiration
Palpation edit
1. With right hand beginning in RLQ, pull the L ribcage forward (give slack for the R hand to feel under the costal margin), palpate superficially toward the LUQ
- assess effect of deep inspiration
- describe: firm/soft, nodular/smooth, tenderness
2. Hooking Maneuver have patient lie on right lateral position
- stand on patient’s left and try hooking hands under left costal margin
Auscultation edit
- all 4 QUADRANTS for bowel sounds
- Friction rub (inflammation, tumor, infarction)
- systolic murmur over spleen - massive splenomegaly (dilated, tortuous splenic artery)
- kidney is BALOTTABLE, spleen is NOT
- NOTCH ON ANTERIOR BORDER - palpable in spleen, not in kidney
- spleen enlarges diagonally towards RLQ, while the kidney enlarges inferiorly
- kidney can be resonant to percussion (d/t overlying bowel), spleen should be DULL
- UPPER EDGE of spleen NOT palpable, upper edge of kidney is
- SPLENIC RUB on auscultation (have patient breathe in and out) and kidney its not