Physical examination maneuver
Physical Exam
Spleen Palpation
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Video coming soon
How to Perform
With the patient supine, stand at the right side and reach across with your left hand to support and gently lift the lower left rib cage from behind. Place your right hand flat on the abdomen, beginning in the right lower quadrant. Press gently inward and upward as the patient takes a deep breath, feeling for the splenic edge to descend against your fingers. If no edge is felt, move your right hand diagonally toward the left upper quadrant in small increments, repeating the maneuver with each inspiration until you reach the left costal margin.
How to Interpret
Showing 7 of 17 findings
Cirrhosis
Palpable spleen tip
Rule in
Somewhat helpful
Rule out
Not helpful
Evidence:Strong
Hepatocellular Jaundice
Palpable spleen in a jaundiced patient, detecting hepatocellular rather than obstructive disease
Rule in
InconclusiveWide CI
Rule out
Not helpfulDerived CI
Evidence:Moderate
Infectious Mononucleosis
Palpable spleen tip in an adolescent or young adult
Rule in
Somewhat helpfulWide CI
Rule out
Minimally helpful
Evidence:Strong
Infective Endocarditis
Palpable spleen tip
Rule in
Somewhat helpfulNo CI
Rule out
Not helpfulNo CI
Evidence:Moderate
Malaria
Palpable spleen in returning travelers with fever
Rule in
Helpful
Rule out
Not helpful
Evidence:Strong
Myelofibrosis
Massive splenomegaly (extending past midline or to pelvis)
Rule in
Somewhat helpfulDerived CI
Rule out
Somewhat helpfulDerived CI
Evidence:Moderate
Splenomegaly
Palpable spleen tip
Rule in
Very helpfulDerived CI
Rule out
Minimally helpfulDerived CI
Evidence:Moderate
Related Bedside Tests
🎬Video coming soon
Abdomen Palpation
Rule in:VHExtrahepatic Biliary Obstruction, VHIntussusception, VHPyloric Stenosis +32 more
Rule out:VHHepatocellular Jaundice, HAppendicitis, SHDiverticulitis +32 more
🎬Video coming soon
Liver Palpation
Rule in:SHCirrhosis, SHHepatomegaly, NHMalignant Lymphadenopathy +7 more
Rule out:SHCirrhosis, SHHepatomegaly, NHMalignant Lymphadenopathy +7 more
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Mouth and Tongue Inspection
Rule in:HHypoxemia, SHAnemia, SHHepatopulmonary Syndrome +16 more
Rule out:HHepatopulmonary Syndrome, SHHypovolemia, MHAnemia +16 more
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Ophthalmoscopy
aka Fundoscopy
Rule in:VHGlaucoma, VHIncreased Intracranial Pressure, SHDiabetic Retinopathy +14 more
Rule out:SHGlaucoma, MHDiabetic Retinopathy, MHIncreased Intracranial Pressure +14 more
🎬Video coming soon
Blood Pressure
Rule in:VHHypovolemia, VHMortality, VHStructural Brain Lesion +22 more
Rule out:VHCardiac Tamponade, VHHypovolemia, HLow Cardiac Output +22 more
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Cardiac Auscultation
Rule in:VHAortic Stenosis, VHHeart Failure, VHHypertrophic Cardiomyopathy +37 more
Rule out:VHAortic Stenosis, VHHypertrophic Cardiomyopathy, VHRight-sided Valvular Lesion +37 more