What Is an Accessory Spleen?

The spleen cannot be touched under normal circumstances. The spleen is a substantial organ rich in blood supply, soft and brittle. It is generally believed that the physiological spleen is 10-12 cm long, 6-8 cm wide, 3-4 cm thick, and weighs 110-200 g. The spleen is located deep in the external costal arch behind the left quarter of the costal region, opposite the 9-11 ribs, with the long axis consistent with the 10th rib. The plantar surface is adjacent to the diaphragm and the left costosacral sinus, with the stomach in the front, the left kidney and the left adrenal gland in the back, the lower end adjacent to the colonic spleen, and the spleen hilum adjacent to the tail of the pancreas. The spleen is an internal organ of the peritoneum, which is connected to adjacent organs by the gastric spleen ligament, spleen-renal ligament, spleen-spleen ligament, and spleen-colon ligament.

Spleen palpation is an auxiliary examination method used to check whether the abdominal spleen is normal. The spleen cannot be touched under normal circumstances. Once touched, it indicates that the spleen is swollen to 2-3 times normal. Clinically, the two-hand palpation method is mostly used. The patient lies on his back with his legs flexed slightly. The doctor's left hand goes around the front of the patient's abdomen. The palm is placed at the 9th to 11th ribs of the left lower chest. Place the right palm flat on the umbilicus, and palpate from the umbilical plane, which is approximately perpendicular to the left costal arch. Like palpation of the liver, cooperate with breathing, gradually upward, and touch the spleen tip to the left costal margin. When the spleen is slightly enlarged and the supine position is not easy to touch, the patient can be instructed to take the right lateral position, flex both lower limbs, and then palpate with both hands for easy access.

Name: Palpation of the spleen

category: Special inspection

Normal spleen palpation

Clinical Significance of Spleen Palpation

Abnormal results: Grading of splenomegaly: Clinically, splenomegaly is generally divided into light, medium, and high degrees. When inhaling deeply, the spleen margin does not exceed 2cm below the ribs, which is mildly swollen; if it exceeds 2cm above the umbilical horizontal line, it is moderately swollen; beyond the umbilical horizontal line or anterior midline, it is highly swollen, also known as giant spleen.
People who need to be checked: routine physical examination items, people with abnormal abdomen.

Spleen palpation precautions

Unsuitable crowd: Basically there is no unsuitable crowd, but people with mental and mental disorders should pay attention.
Requirement during examination: Measurement of splenomegaly: usually three lines are used: "1" line (also known as A-B line) refers to the distance from the left costal margin of the left midclavicular line to the lower edge of the spleen (expressed in cm). Only the first measurement is made when the spleen is slightly enlarged. When the "2" and "3" lines are swollen obviously, the "2" line (methyl-C line) and the "3" line (Ding line) should be added. The former refers to the intersection of the left midclavicular line and the left costal margin. The distance of the furthest point of the spleen (should be greater than the "1" line), which refers to the distance from the right edge of the spleen to the anterior midline. If the spleen height increases and crosses the median line to the right, the maximum distance from the right edge of the spleen to the median line is measured as "+"; if it does not exceed the median line, the shortest distance from the right edge of the spleen to the median line is measured and expressed as "-" .

Spleen palpation examination process

(1) Superficial palpation method: When the spleen is enlarged and superficial, the palpated spleen can be touched with one hand with only one hand.
(2) Double palpation method: when the spleen is enlarged, the palpation method should be used for examination. The patient was instructed to bend his knees in the supine or right-side position, and the examiner's left hand was supported forward at the 7-10th rib behind the spleen, and the thorax was fixed as much as possible. The patient was instructed to perform abdominal deep breathing exercises. The examiner's right hand was placed flat on the abdomen, the long axis of the hand was perpendicular to the left costal arch, and then gradually approached the left costal arch from bottom to top. The fingers were slightly bent and gently pressed into the abdominal wall. When the patient inhales deeply, the spleen drops and touches the palpated finger, which can touch the lower edge of the spleen. When the patient is slightly swollen and difficult to reach in the supine position, the patient can be instructed to switch to the right position. The patient's right lower extremity is straightened, and the left lower extremity is flexed with hips and knees for examination. It is easier to touch the slightly enlarged spleen.
(3) Impact palpation method: used for palpation of the spleen in patients with ascites.
(4) Counterattack method: This method determines the adhesion of the spleen by checking the spleen's mobility. The method is similar to the two-hand palpation method, with one hand resting on the spleen surface of the anterior abdominal wall and immobilized; the other hand pushing against the space in the space below the ribs on the outside of the back of the iliac spine muscle, pushing against the forward abdominal wall, and can be repeated several times. If the hand on the front abdominal wall has a feeling of impact, it means that there is no adhesion around the spleen.
Content of palpation: including the size of the spleen, surface condition, texture, edges, presence of tenderness and friction.

Palpation related diseases

Hypersplenism, neonatal liver and splenomegaly, spleen abscess, chronic congestive splenomegaly in children, splenomegaly in children, spleen water, splenomegaly, spleen cyst

Spleen palpation- related symptoms

Four laziness, cold and wet indulgence, limb weight drowsiness, bruising claw nails, paroxysmal limb muscle stiffness, eyes closed and shaking head, shortness of breath, stagnation of gas, tenderness, giant spleen