Is this normal?

RNMeg · May 9, 2008

I don't think that's normal. I'm just a student..but in Assessment last semester we were told nothing should be palpable there. In fact, we were told if you *could* feel something, you shouldn't touch it, because it could be an enlarged spleen that could rupture. Again, just a student, putting in my :twocents:

allnurses Guide · May 9, 2008

Ms RN describe what you could feel, it may make it easier to answer your question. What organ do you think you could feel (only because you state organ rather than the specific organ that you may feel there)l, how did it feel, was it smooth, mobile static that kind of thing.

Patient history would be useful as well, to intepret your findings

kristenncrn · May 9, 2008

I don't do deep palp on my patients... but if you felt the spleen (and I assume you mean the spleen by organ due to location) on an adult - that's abnormal.

It's tough, though, because from journal articles - many times muscle guarding is interpreted as an enlarged spleen (or liver, or whatever depending on location.) So personally, I usually try and get a second opinion.

If there is a known reason for an enlarged spleen, I am very careful not to push too hard!!

Causes of splenomegaly are many...

leslie :-D · May 9, 2008

no it's not normal.

the md should be made aware of your findings.

leslie

Dorito, ASN, RN · May 9, 2008

I was palpating an abdomen of an obese women in with abdominal pain....she'd had CT scans and a surgeon consult and I was palpating on the right and felt a mass...I got the MD and he came in and here she had gall stones and the CT scanner hadn't even diagnosed them. It earned me a box of candy from the doc though. :)

TiredMD · May 10, 2008

ironically, this question has actually been studied.

med j aust. 1986 jul 7;145(1):15-7.
a palpable spleen is not necessarily enlarged or pathological.
arkles lb, gill gd, molan mp.
it is widely accepted that a palpable spleen in the adult population is always enlarged and pathological. the aim of this study was to assess the validity of this statement. as a routine, our protocol for liver-spleen studies includes liver pliability, which demonstrates the level of the hemidiaphragms at full inspiration and expiration, as well as splenic size and colloidal uptake. sixteen hundred 99mtc sulphur colloid liver-spleen studies, which had been performed in our department, were reviewed. in 21 patients, who had been referred with "splenomegaly for investigation", the scintigraphic splenic size was 13 cm posterior length or less. in this group, splenic palpability was confirmed by at least two clinicians. follow-up did not reveal any evidence of splenic disease in 18 of the 21 patients. in a separate postmortem follow-up of 123 sequential liver-spleen scans, 100 patients were noted to have a scintigraphic splenic size of 13 cm posterior length or less. this was shown to be a reliable upper limit of normal because 98% of spleens in this group weighed 250 g or less and were normal at post-mortem examination. this study demonstrates that a palpable spleen is not necessarily enlarged or pathological.

**canoehead, BSN, RN** · May 10, 2008

If you palpate a piano in there- now that might be something.

:yeah: :yeah: