Assessment of the Spleen

 

The Normal Spleen

The spleen lies within the peritoneal cavity in the posterior portion of the left upper quadrant. The normal size of the spleen correlates with a person's height, weight, and sex. In one study, the upper limits of normal for the tallest females and males were approximately 12.3 and 14.5 cm respectively. 

Common Terms Relating to the Spleen

Accessory spleen – A separate region of splenic tissue in the abdomen, present in approximately 15 percent of individuals.

Asplenia – Absence of the spleen or absent splenic function (also called functional asplenia or autosplenectomy). This may be caused by surgical splenectomy or a condition such as sickle cell disease in which splenic infarction early in life causes loss of splenic function. 

Hyposplenia – Reduced splenic function. Milder forms of sickle cell disease such as hemoglobin SC disease or sickle-beta+ thalassemia may cause hyposplenia. An autoimmune disorder in which T or B lymphocyte function is impaired may affect antibody production and/or cell-mediated immunity without impacting other functions. 

Splenomegaly – Increased spleen size. Non-pathologic anatomical variations are common, and mild deviations from the standard range may be normal.

Hypersplenism – Splenic sequestration and/or destruction of blood cells extensive enough to cause one or more cytopenias. 

Splenosis – Seeding of the abdominal cavity with splenic cells that can occur during surgery or trauma. 

Physical Exam Technique

Palpation

1. Start in RLQ
2. Get your fingers set then ask patient to take a deep breath. Don’t dip your fingers or push inwards.
3. When patient expires, take up new position.
4. Note lowest point of spleen below costal margin, texture of splenic contour, and tenderness
5. If spleen is not felt, repeat with pt lying on right side. Gravity may bring spleen within reach.

Note: Enlarged spleens can be fragile and easily injured on palpation, let the spleen touch your fingers and instead of aggressively digging for it!

Percussion

Castell's sign: place the patient in the supine position. With the patient in full inspiration and then full expiration, percuss the area of the lowest intercostal space in the left anterior axillary line. If the note changes from resonant on full expiration to dull on full inspiration, the sign is regarded as positive for splenomegaly.

Other

The use of bedside ultrasound may increase the sensitivity and specificity of the traditional physical examination in determining if the spleen is enlarged. 

References

https://www-uptodate-com.myaccess.library.utoronto.ca/contents/evaluation-of-splenomegaly-and-other-splenic-disorders-in-adults?search=splenomegaly&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

https://stanfordmedicine25.stanford.edu/the25/spleen.html

https://pubmed-ncbi-nlm-nih-gov.myaccess.library.utoronto.ca/26509293/ 

A.L.