The spleen is an unpaired organ that is located on the left side of the abdominal cavity. The anterior part of the organ is adjacent to the stomach, and the posterior part to the kidney, adrenal gland and intestines.
Structure of the spleen
In the composition of the spleen, a serous cover and its own capsule are determined, the latter is 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 "islands" with the help of 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: erythrocytes (mostly decaying), leukocytes and lymphocytes.
Functions of Organ
- The spleen is involved in lymphopoiesis (that is, it is a source of lymphocytes).
- Participates in the hematopoietic and immune functions of the body.
- Destruction of used platelets and red blood cells.
- Blood deposit.
- In the early stages of embryogenesis, it works as a hematopoietic organ.
That is, the body performsmany 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 sequence of palpation of internal organs
After collecting complaints, anamnesis and general examination, the doctor, as a rule, proceeds to physical research methods, which include palpation and percussion.
Distinguish:
- Superficial palpation, which reveals pain in a particular area, tension in the abdominal muscles, swelling, various seals and formations (hernias, tumors, nodes). It is carried out by light pressure with half-bent fingers, starting from the left iliac region counterclockwise.
- Deep palpation, carried out in the following sequence: caecum, ileum (its final part), colon (ascending and descending sections), transverse colon, stomach, liver, pancreas, spleen, kidneys, is carried out using deep penetration of the doctor's fingers into the abdominal cavity.
In case of suspected spleen disease (or its enlargement due to liver disease), percussion, palpation of the liver and spleen is mandatory.
General rules of palpation
Probing (palpation) of the spleen is one of the most informative physical research methods conducted by a doctor. In the case of a slight increase in the organ, when the spleen is not easilyprobe, the doctor definitely recommends an ultrasound scan to confirm / refute the alleged pathology in a child or adult.
Patient position:
- Lying on the 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 Sali palpation of the spleen). Moreover, the patient's head should be slightly tilted to the chest, the right leg is straight, and the left leg should be bent at the hip and knee joints.
Spleen palpation: algorithm
- The doctor should place his left hand so that it is on the left side of the subject's chest, between the 7th and 10th ribs in accordance with the axillary lines, and apply slight pressure. In this case, the fingers of the right hand should be half-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 pulled down to form a skin fold.
- After exhalation, the doctor's hand penetrates deep into the abdomen (abdominal cavity).
- The patient, at the request of the doctor, inhales deeply, while under the influence of the diaphragm, the spleen moves down. In the case of its increase, the doctor's fingers will come across its lower pole. This action must be repeated several times.
Interpretation of results
Under normal conditions (in he althy people) the spleen is not palpable. An exception is asthenics (usually women). In other cases, it is possible to feel the spleen when the diaphragm is lowered (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 liver pathologies (here splenomegaly is a sign of portal hypertension or hepatolienal syndrome).
- Chronic and acute infectious processes (infectious endocarditis, malaria, typhoid, sepsis).
- Diseases of connective tissue.
- Infarcts or abscesses of the spleen.
Most often, palpation of even an enlarged spleen is painless. The exceptions are organ infarcts, rapid expansion of the capsule, perisplenitis. In these cases, the spleen becomes extremely sensitive (i.e. painful to palpation).
With cirrhosis of the liver and other chronic pathologies, the edge of the spleen is dense, while in acute processes it is soft.
Consistency is usually soft in acute infections, firm in chronic infections and cirrhosis.
According to the degree of enlargement of the organ, the palpable part may be smaller or larger, and the extent to which the spleen has come out from under the ribs may indicate the true degree of enlargement of the organ. So, a relatively small increase is indicated by the exit of the edge of the organ from under the costal arch by 2-7 centimeters, which is observed in acute infections (typhus, meningitis, sepsis, croupous pneumonia, and so on) or chronicpathologies (heart disease, cirrhosis, erythremia, leukemia, anemia) and unknown etiology, which occurs more often in young people (possibly with hereditary syphilis, rickets)
According to the density of the palpable edge of the spleen (with its increase), it is possible to draw conclusions about the age of the process. That is, the longer inflammation is present in the organ, the denser and harder its parenchyma, which means that in acute processes the edge of the spleen is softer and more elastic than in chronic ones.
When the organ is too large, when the lower edge is determined in the pelvic cavity, it is very easy to palpate the spleen, and no special skills are required.
In the case of splenomegaly as a result of a neoplasm, palpation of the spleen (more precisely, its margo crenatus) notches (from 1 to 4) are determined. A similar diagnostic sign indicates the presence of amyloidosis, leukemia (chronic myelogenous or pseudoleukemia), malaria, cysts and endothelioma.
That is, when palpating the spleen, the doctor has the opportunity to assess the condition of its surface, detect fibrin deposits (as, for example, with perisplenitis), various protrusions (which happens, for example, with abscesses, hemorrhagic and serous cysts, echinococcosis) and determine the density of tissues. With abscesses, swell is often found. All information determined by palpation is extremely valuable both for diagnosing a disease of the spleen itself, and for determining diseases that could lead to splenomegaly.
Normally, the spleen is located in the region of the left hypochondrium, its long axislocated along the tenth rib. The organ 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: up to 60mm wide and 100-120mm long.
It should be remembered that palpation of the spleen in children, as well as in adults, should be painless, in addition, normally the spleen in a child is not determined. The sizes described above are not absolute, that is, small deviations towards a decrease / increase in the size of an organ should not be regarded as a pathology.
Spleen percussion
This method is used to estimate the size (boundaries) of an organ.
The patient is placed in the right semi-lateral position with the arms above the head, while the legs are slightly bent at the hip and knee joints. Percussion should be done by moving from a clear to a dull sound, using quiet percussive beats.
Percussion performance
- The finger plessimeter must be placed on the edge of the costal arch on the left side of the body, perpendicular to the 10th rib.
- Perform weak percussion on the 10th rib, first fromcostal arch (left) until a dull sound (dullness) appears. A mark is made on the skin at the point of sound transition. Then they percuss from the axillary line (back) anteriorly until the sound becomes dull and also put a mark on the skin.
- The length of the segment between the marks is the length of the spleen (corresponding to the 10th rib). Normally, this indicator is 6-8 centimeters.
- From the middle of the length, perpendiculars are drawn to the tenth rib and further percussion is performed along them to determine the diameter of the spleen, which normally ranges from 4 to 6 centimeters.
- Normally, the anterior part of the spleen (that is, its edge) should not go medially to the line that 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 size of the organ is written as a fraction, where the numerator is the length, and the denominator is the diameter of the spleen.
