On clinical examination of patient with abdominal pain, you find a mass in the left hypochondrium. List 4 clinical features will you use to distinguish between a palpable spleen and the left kidney?
Presence of a notch – spleen
Spleen moves inferomedially on inspiration
Not ballotable or bimanually palpable
Usually no band of resonance over s splenic mass
Spleen has no palpable upper border
Dullness over ribs 9,10, 11
This is another question which reaches into a deep dark recess of Talley and O'Connor.
The differences between spleens and kidneys are mobility, ballotability, and edge palpation.
- Thus, the spleen is mobile with respiration, whereas the kidneys is not.
- The kidney is "ballotable" whereas the spleen is not.
- The spleen has a notch on the anterior surface, and the kidney does not
- The spleen should be dull to percussion, where the kidney can be resonant due to overlying gas
- The spleen enlarges diagonally, towards the umbilicus and the RLQ, whereas the kidney enlarges inferiorly, to the ipsilateral pelvis.
- There is no palpable upper border to the spleen, whereas the kidney should have one
The reference for the above wisdom, shamefully, is Wikiversity.