The spleen is an unpaired organ that is located on the left side of the abdominal cavity. The front of the organ is adjacent to the stomach, and the back to the kidney, adrenal gland and intestines.
Spleen structure
The composition of the spleen determines the serous cover and its own capsule, the latter formed by a combination of connective tissue, muscle and elastic fibers.
The capsule passes into the body of the organ, dividing the pulp (parenchyma) into separate "islets" using trabeculae. In the pulp (on the walls of the arterioles) there are round or oval nodules of lymphoid tissue (lymphoid follicles). The pulp is based on reticular tissue, which is filled with a variety of cells: red blood cells (mostly decaying), white blood cells and lymphocytes.
Body functions
- The spleen is involved in lymphopoiesis (that is, it is a source of lymphocytes).
- Participates in the blood-forming and immune functions of the body.
- Destruction of spent platelets and red blood cells.
- Deposition of blood.
- In the early stages of embryogenesis, it works as a hematopoietic organ.
That is, the organ performs many important functions, and therefore, to determine pathologies at the initial stages of the examination, it is necessary first of all to perform palpation and percussion of the spleen.
The order of palpation of internal organs
After collecting complaints, an anamnesis and a general examination, the doctor, as a rule, proceeds to physical research methods, which include palpation and percussion.
Distinguish:
- Superficial palpation, in which soreness of a particular area, tension of the muscles of the abdomen, swelling, various seals and formations (hernias, tumors, nodes) are detected. It is carried out by light pressure with bent fingers, starting from the left iliac region counterclockwise.
- Deep palpation, carried out in the following sequence: cecum, ileum (its final part), colon (ascending and descending sections), transverse colon section of the intestine, stomach, liver, pancreas, spleen, kidneys, is carried out using deep finger penetration doctors in the abdominal cavity.
In case of suspicion of the presence of diseases of the spleen (or its increase due to liver diseases), percussion, palpation of the liver and spleen is mandatory.
General rules of palpation
Palpation of the spleen is one of the most informative physical research methods conducted by a doctor. In the case of a slight enlargement of the organ, when the spleen is not easy to feel, the doctor always recommends an ultrasound scan to confirm / refute the alleged pathology in a child or adult.
Patient Position:
- Lying on your back (in this position, palpation of the liver and spleen is performed).
- Lying on the right side. The right hand is located under the head, and the left should be bent at the elbow and laid on the chest (this technique is called palpation of the spleen according to Sali). Moreover, the patient’s head should be slightly inclined to the chest, the right leg is straight, and the left leg should be bent at the hip and knee joints.
Palpation of the spleen: algorithm
- The doctor should position his left hand so that it is on the left side of the patient’s chest, in the interval between the 7th and 10th rib in accordance with the axillary lines, and exert slight pressure. In this case, the fingers of the right hand should be bent and located on the left costal arch so that the middle finger is adjacent to the 10th rib.
- When the patient inhales, the skin is shifted down to form folds of the skin.
- After exhalation, the doctor’s hand penetrates deep into the abdomen (abdominal cavity).
- At the request of the doctor, the patient inhales deeply, while under the influence of the diaphragm the spleen moves down. If it increases, the doctor’s fingers will bump into her lower pole. This action must be repeated several times.
Interpretation of the results
Under normal conditions (in healthy people), the spleen is not palpable. The exception is asthenics (usually women). In other cases, the spleen can be felt with the omission of the diaphragm (pneumothorax, pleurisy) and splenomegaly, that is, an increase in the size of the organ. A similar condition is more often observed in the following conditions:
- Blood diseases.
- Chronic pathologies of the liver (here splenomegaly is a sign of portal hypertension or hepatolienal syndrome).
- Chronic and acute infectious processes (infective endocarditis, malaria, typhoid, sepsis).
- Connective tissue disease.
- Heart attacks or abscesses of the spleen.
Most often, palpation of even an enlarged spleen is painless. The exceptions are organ heart attacks, rapid extension of the capsule, perisplenitis. In these cases, the spleen becomes extremely sensitive (i.e. painful on palpation).
With cirrhosis of the liver and other chronic pathologies, the edge of the spleen is dense, while in acute processes it is soft.
The consistency is usually mild in acute infections, with chronic infections and cirrhosis of the liver becomes dense.
Accordingly, the degree of organ enlargement, the palpable part can be smaller or larger, and how much the spleen has left the ribs can indicate the true degree of organ enlargement. So, a relatively small increase is indicated by the exit of the organ edge from under the costal arch by 2-7 centimeters, which is observed in acute infections (typhoid, meningitis, sepsis, croupous pneumonia, etc.) or chronic pathologies (heart disease, cirrhosis, erythremia, leukemia, anemia) and an unknown etiology, which often occurs in young people (possibly with hereditary syphilis, rickets)
Accordingly, the density of the palpable edge of the spleen (with its increase) it is possible to draw conclusions about the prescription of the process. That is, the longer the inflammation is present in the organ, the denser and firmer its parenchyma, which implies that in acute processes the spleen edge is softer and more elastic than in chronic ones.
If the organ is too large, when the lower edge is defined in the pelvic cavity, palpation of the spleen is very simple, and special skills are not required.
In the case of splenomegaly as a result of neoplasm during palpation of the spleen (more precisely, its margo crenatus), nicks (from 1 to 4) are determined. A similar diagnostic symptom indicates the presence of amyloidosis, leukemia (chronic myelogenous or pseudo-leukemia), malaria, cysts, and endotheliomas.
That is, during palpation of the spleen, the doctor has the opportunity to assess the condition of its surface, detect fibrin deposition (as, for example, with perisplenitis), various protrusions (which happens, for example, with abscesses, hemorrhagic and serous cysts, echinococcosis) and determine the density of tissues. When abscesses are often found and swelling. All the information determined by palpation is extremely valuable both for diagnosing the disease of the spleen itself and for identifying diseases that could lead to splenomegaly.
Normally, the spleen is located in the region of the left hypochondrium, its long axis is located along the tenth rib. The body has an oval (bean-shaped) shape.
Spleen in childhood
The size of the spleen is normal depending on age:
- Newborns: width - up to 38 millimeters, length - up to 40 millimeters.
- 1-3 years: length - up to 68 millimeters, width - up to 50 millimeters.
- 7 years: length - up to 80 millimeters, width - up to 55 millimeters.
- 8-12 years: width - up to 60 millimeters, length - up to 90 millimeters.
- 15 years: width - up to 60 millimeters, and length - 100-120 millimeters.
It should be remembered that palpation of the spleen in children, as well as in adults, should be painless, in addition, the normal spleen in a child is not determined. The dimensions described above are not absolute, that is, small deviations in the direction of reducing / increasing the size of the organ should not be regarded as a pathology.
Spleen percussion
This method is used to assess the size (boundaries) of the body.
The patient is placed in the right semi-lateral position with arms located above the head, while the legs are barely bent at the hip and knee joints. Percussion follows, moving from a clear to a dull sound, using quiet percussion strokes.
Percussion
- The finger-pessimeter must be installed on the edge of the costal arch on the left side of the body, perpendicular to the 10th rib.
- Spend a slight percussion along the 10th rib, first from the costal arch (left) to the appearance of a dull sound (blunting). At the point of transition of sound make a mark on the skin. Then it is percussed from the axillary line (back) anteriorly until the sound becomes dull and a mark is also placed on the skin.
- The length of the segment between the marks is the length of the spleen (corresponding to the 10th rib). Normally, this figure is 6-8 centimeters.
- Perpendiculars are drawn from the middle of the length to the tenth rib and further percussion is performed on them to determine the spleen diameter, which normally ranges from 4 to 6 centimeters.
- Normally, the anterior part of the spleen (that is, its edge) should not go more medially than the line, which connects the free end of the 11th rib and the sternoclavicular joint. It is worth noting that the calculation of the size of the spleen using percussion is a very approximate indicator. The dimensions of the organ are recorded as a fraction, where the numerator is the length, and the denominator is the diameter of the spleen.