Haem Exam


The Patient

The Hands

The Arms

The Face

The Neck

The Chest

The Abdomen

The Pelvis

The Back

The Legs

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The Spleen

    • How to Elicit
    • Apply gentle pressure to the right lower quadrant. Ask the patient to take a deep breath in. Move the hand superiorly and medially each time the patient breathes out and repeat until the left costal margin is reached. Repeat with the patient in the right lateral decubitus position.
    • Interpretation
    • Splenomegaly is present if the spleen is palpable.
    • Causes of Splenomegaly
    • Congestion - congestive cardiac failure, portal vein thrombosis, cirrhosis
    • Infection - bacterial / viral / parasitic
    • Inflammation - SLE, IBD, rheumatoid arthritis
    • Haematological - leukaemia / lymphoma, thalassaemia, sickle cell anaemia, haemolytic anaemia
    • Systemic - sarcoidosis, amyloidosis
    • Malignancy - leukaemia, lymphoma, splenic tumours, metastases
  • Massive splenomegaly is uncommon and occurs in the setting of CML, myelofibrosis, certain lymphomas, malaria and leichmaniasis.