The Abdominal Exam


LSU Physician Champions - Dr. Daniel Raines and Dr. Kellen Jex


Assessment for Splenomegaly

Assessment for Splenomegaly


The spleen is typically not palpable unless it is enlarged, and is often difficult to palpate even if splenomegaly is present.
Palpation for the spleen should begin in the right lower quadrant, as it enlarges in the inferior anteromedial direction.
Apply very light pressure with the fingers, and ask the patient to take a deep breath. You may feel the edge of the spleen during inhalation. Reposition your hand during the exhale, and move slowly across the abdomen towards the left costal margin. Note the lowest point of the spleen, if it is palpated. You may attempt to lift the spleen by placing the right hand on the posterior aspect of the patient’s left flank.
This examination can be completed with the patient in the right lateral decubitus position, which facilitates a downward movement of the spleen, and thus increased success of palpation, via gravity.