The spleen is an unpaired organ that is located in the left part of the abdominal cavity. The anterior part of the organ is attached to the stomach, and the posterior part to the kidney, adrenal and intestines.
The composition of the spleen determines the serosa and its own capsule, the latter is formed by a combination of connective tissue, muscle and elastic fibers.
The capsule passes into the core of the body, separating the pulp(parenchyma) to separate "islets" with the help of trabeculae. In the pulp (on the walls of arterioles) there are round or oval nodules of lymphoid tissue (lymphoid follicles). At the heart of the pulp lies the reticular tissue, which is filled with various cells: red blood cells (mostly decaying), leukocytes and lymphocytes.
That is, the body performs many important functions, and therefore for the definition of pathologies at the initial stages of the examination, it is first of all necessary to perform palpation and percussion of the spleen.
After collecting complaints, anamnesis and general examination, the physician, as a rule, proceeds to physical methods of research, which include palpation and percussion.
Distinguish:
In case of suspicion of the presence of diseases of the spleen (or its increase due to liver disease) it is necessary to perform percussion, palpation of the liver and spleen.
Прощупывание (пальпация) селезенки - один из the most informative physical methods of research conducted by a doctor. In the case of a slight increase in the organ, when the spleen is not easy to probe, the doctor necessarily recommends the passage of ultrasound to confirm / disprove the alleged pathology in the child or adult.
Patient's situation:
Under normal conditions (in healthy people)the spleen is not palpable. Exceptions are asthenics (more often women). To probe the spleen in other cases it is possible at the descent of the diaphragm (pneumothorax, pleurisy) and splenomegaly, that is, an increase in the size of the organ. Such a state is more often observed under the following conditions:
Most often, palpation of an enlarged spleenpainless. Exceptions are organ infarcts, rapid capsule stretching, perisplenitis. In these cases, the spleen becomes extremely sensitive (that is, painful on palpation).
With cirrhosis of the liver and other chronic pathologies, the edge of the spleen is dense, while in acute processes it is mild.
Consistency is usually mild in acute infections, with chronic infections and cirrhosis becomes dense.
Correspondingly, the degree of organ enlargementthe palpable part may be smaller or larger, and the extent to which the spleen has emerged from under the ribs may indicate a true degree of organ enlargement. Thus, a relatively small increase indicates the outlet of the edge of the organ from beneath the costal arch to 2-7 centimeters, which is observed in acute infections (typhoid, meningitis, sepsis, croupous pneumonia and so on) or chronic pathologies (heart disease, cirrhosis, erythremia, leukemia, anemia) and unexplained etiology, which often occurs in young people (possibly with hereditary syphilis, rickets)
Accordingly, the density of the probe edgespleen (with its increase) it is possible to draw conclusions about the prescription of the process. That is, the longer there is inflammation in the organ, the denser and harder its parenchyma, from which it follows that in acute processes the edge of the spleen is more soft and elastic than in chronic ones.
If the size of the body is too large, when the lower edge is defined in the pelvic cavity, it is very easy to perform palpation of the spleen, and no special skills are required.
In the case of splenomegaly as a result ofneoplasms in the palpation of the spleen (more precisely, its margo crenatus) defined notches (from 1 to 4). Such a diagnostic sign indicates the presence of amyloidosis, leukemia (myelogenous chronic or pseudo-leukemia), malaria, cysts and endothelium.
That is, when performing a palpation of the spleen, the doctorhas the opportunity to assess the state of its surface, to detect the deposition of fibrin (as, for example, with perisplenitis), a variety of protrusions (as happens, for example, with abscesses, hemorrhagic and serous cysts, echinococcosis) and determine tissue density. When abscesses are often found and swelling. All the information determined by palpation is extremely valuable, both for diagnosing the disease of the spleen itself, and for determining the diseases that could lead to splenomegaly.
Normally, the spleen is located in the region of the left hypochondrium, its long axis is located along the tenth rib. The organ has an oval (bean-shaped) shape.
Spleen sizes are normal, depending on age:
It should be remembered that palpation of the spleen in children,as well as in adults, should be painless, in addition, in the normal spleen in a child is not defined. The dimensions described above are not absolute, that is, small deviations in the direction of decreasing / increasing the size of the organ should not be regarded as pathology.
This method is used to estimate the size (boundaries) of an organ.
The patient is placed in the right half-sidedposition with the hands above the head, with the legs barely bent at the hip and knee joints. Percussion follows, moving from clear to blunt sound, using quiet percussion beats.
