The spleen is a small organ about the size of a fist; it sits up under the diaphragm in the left upper quadrant of the abdomen. In temperate climates, like Canada, the spleen does not figure prominently in general medical practice. It is of interest mainly in patients with lymphoma and leukemia and in teen-agers with infections mononucleosis.
Here in the tropics, however, the spleen is paramount. It becomes enlarged serving its primary function, which is to protect the body from infectious agents. In malaria, kala azar and schistosomiasis, the spleen can become massive, stretching from the upper left part of the abdomen to the pelvis. It can also be enlarged in brucellosis, typhoid and even tuberculosis.
We were taught in medical school to start examining for the spleen in the lower part of the abdomen. The technique is to work your way upwards towards the chest, all the while asking the patient to take deep breathes. If the spleen is enlarged you will be able to palpate it with your fingertips as the patient inspires and the diaphragm pushes the spleen down. Sometimes, you can see the spleen with your naked eye, especially if the patient is very thin, and the spleen is very large.
Here in Lankien, spleen palpation is a refined art.