Its a patient age 66 alert to time place and people, laying comfortably supine with a massive splenomegaly on palpation. She had no other findings beside that. upon my friend's clark the patient actually had chronic cirrhosis that eventually leads to the splenomegaly.
She had no hepatomegaly as cirrhosis involve the shrinking of the liver. cirrhosis is always related to portal hypertension, thus the leading question are whether any bleeding like hemetemesis happens. this also may contribute to the large spleen that happen to be due to a congestion of blood there.
Also we need to ask any history of doing scope before.
Also the portal hypertension can lead to encelopathy and thats the reason to ask for while we approached a patient of abdominal problem.
Also we learn the right way to do examination.
1. Not to be too close to the bed
2. minimise contact with the patient.
3. Pull the sleeve (for muslimat its important to wear maksum especially in this condition)
4. Showmanship (show that what you are doing; example: stand at the end of bed and take afew seconds there)
5. Make instruction clear for the patient to follow.
6. if patient pain try to go for the other parts first.
7. let go off your finger immediately after a percuss to avoid absorbing the sound
8. the spleen we must start palpate from right lower quadrant so that we would not miss any large spleen.
9. the finger to test for spleen must be at the tips of finger as we want to feel it when it fall on inspiration
10. you can do ballotingthe kidney immediately after you ask patient to lean over while doing shifting dullness (can avoid much movement) and can check also the sacrall edema.
11. No need to measure the liver span if no hepatomegaly(some dr are not in agreement over this)
12. for superficial palpation on abdomen its enough to touch no need to press as we only want to see any pain, ex: peritonitis is painful even a touch.
well. these are among the tips we get in the bedside teaching.
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