Examination of the Spleen
Examination of the spleen requires the examiner to palpate from the right iliac fossa up to the left upper quadrant and this may be shortened again by percussing the area first. The spleen is essentially a posterior organ (see attached CT scan) and generally needs to be significantly enlarged before it becomes palpable .Examination may be easier with the examiner resting his left hand just below the ribs in the left posterior chest and feeling in the left upper quadrant. It is important with as with the examination of the liver that the examiner keeps his hand still as a patient takes a deep breath.If you strongly suspect a spleen ask the patient to roll onto his left side-this will sometimes make the spleen easier to feel.
Splenic enlargement may be categorised as mild moderate or massive, with massive spleens extending to the right iliac fossa .The maximum distance of the spleen below the left costal margin is recorded in the clinical notes. Clinical examination fails to detect splenomegaly in approximately half of cases.Ultrasound is a very sensitive examination for detection of splenic enlargement and should be undertaken when splenic enlargement is suspected but not found clinically eg suspected myeloproliferative disorder.