tailieunhanh - Examination of the spleen

Document "Probiotics and prebiotic" presentation of content: Positioning and draping, inspection, percussion, the landmarks used in Nixon’s Method, The Landmarks for Traube’s Space and the area to percuss to elicit Castell’s sign. | Examination of the Spleen Wash your hands Introduce the exam to your patient Positioning Draping Position the patient so that their abdominal muscles are relaxed. Therefore the patient o is lying flat o has arms at their sides o has a pillow Drape so that the abdomen is visible from the nipples to at least the Anterior Superior Iliac Spines ASIS s Inspection Look for masses scars and lesions trauma atrophy hypertrophy discolouration swelling muscle bulk symmetry distended abdomen Splenomegaly -a bulging mass may be seen emerging from under the Left costal margin extending diagonally towards the Right Lower Quadrant RLQ Percussion 3 methods Percussion of Traube s Space o boundaries -Left anterior axillary line 6th rib costal margin see Figure 1 o this area should be resonant on percussion o dullness indicates possible splenic enlargement 1 Michael Colapinto Percussion by Castell s method o percuss in the lowest Left intercostal space in the anterior axillary line usually the 8th or 9th IC space -see Figure 1 o this space should remain resonant during full inspiration o dullness on full inspiration indicates possible splenic enlargement a positive Castell s sign Figure 1 The Landmarks for Traube s Space and the area to percuss to elicit Castell s sign Percussion by Nixon s method optional see Figure 2 o place the patient in Right lateral decubitus o begin percussion midway along the Left costal margin o proceed in a line perpendicular to the Left costal margin o if the upper limit of dullness extends 8 cm above the Left costal margin this indicates possible splenomegaly 2 Figure 2 The landmarks used in Nixon s Method Palpation 4 methods Method 1 o begin palpation in the RLQ o direct the patient s breathing by telling them when to take a deep breath and when to eXhale o while proceeding diagonally towards the Left Upper Quadrant LUQ try to palpate the spleen edge during each inspiratory phase Method 2 o place your Left hand under patient s Left posterior chest at pull