Palpation of the spleen

Definition: The spleen is about the size of a fist and is located in the left hypochondrium beneath the rib cage usually.
In normal healthy individuals the spleen is not palpable. Enlargement is a sign of abnormality.

In enlargement of the spleen the organ expands along the line of the 9th rib and travels downwards and inwards on inspiration into the 9th intercostal space. Depending on the individual the spleen could be found between the 9th and 11th rib.

When the spleen enlarges it also concurrently projects towards the umbilicus and towards the right iliac fossa, evident on palpation (see Considerations).

Test procedure: Abdominal palpation should be performed checking for tenderness, distension, guarding, and rebound tenderness with particularly emphasis on the left hypochondrium. Beginning in the right iliac fossa palpate in a diagonal direction towards the left hypochondrium noting any discomfort, abnormalities and enlargement that may be particularly evident on inspiration.

The Bimanual Spleen Technique is used also to palpate the spleen, the examiner should place one hand under the patient in the flank region and the other dominant palpating hand on top just below the umbilicus with fingers pressing on the borders of the costal margin proximal to the 9th to 12th rib are. Ask the patient to take a deep inspiration and press relatively firmly with the palpating hand on top to detect any enlargement or tenderness.

Test findings: In splenomegaly the spleen takes on a characteristic notchy feeling that usually differentiates it from other surrounding organs or structures such as the kidney.
The spleen on inspiration will move down and obliquely inwards as opposed to the kidney which merely descends .

Considerations:
A spleen is normally only palpable when it is approximately double its usual size.
Percussion of Traub’s space is potentially a useful accompanying diagnostic method in suspected pathologies of the spleen.