Spleen Palpation

With your left hand, reach over and around the patient to support and press forward the lower left rib cage and adjacent soft tissue. With your right hand below the left costal margin, press in toward the spleen. Begin palpation low

An enlarged spleen may be missed if the examiner starts too high in the abdomen to feel the lower edge.

enough so that you are below a possibly enlarged spleen. (If your hand is close to the costal margin, moreover, it is not sufficiently mobile to reach up under the rib cage.) Ask the patient to take a deep breath. Try to feel the tip or edge of the spleen as it comes down to meet your fingertips. Note any tenderness, assess the splenic contour, and measure the distance between the spleen's lowest point and the left costal margin. In a small percentage of normal adults, the tip of the spleen is palpable. Causes include a low, flat diaphragm, as in chronic obstructive pulmonary disease, and a deep inspiratory descent of the diaphragm.

Diaphragm Disorder

A palpable spleen tip, though not necessarily abnormal, may indicate splenic enlargement. The spleen tip below is just palpable deep to the left costal margin.

Physical Examination Spleen

Repeat with the patient lying on the right side with legs somewhat flexed at hips and knees. In this position, gravity may bring the spleen forward and to the right into a palpable location.

Spleen Location Images

Umbilicus

PALPATING THE SPLEEN—PATIENT LYING ON RIGHT SIDE

The enlarged spleen shown below is palpable about 2 cm below the left costal margin on deep inspiration.

Umbilicus

PALPATING THE SPLEEN—PATIENT LYING ON RIGHT SIDE

Palpation Umbilicus
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Responses

  • Petros
    How to measure spleen physical exam?
    4 years ago
  • dora
    What is palpable spleen tip?
    2 years ago
  • samwise
    How to measure spleen size physical exam?
    3 months ago

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