Reticulo-Endothelial Examination

Reticulo-Endothelial is a medical way of saying “Examine the lymph nodes, liver and
spleen”.

Subject steps
1. Wash your hands, introduce yourself to the patient and clarify their identity. 
Explain what you would like to do and obtain consent.  The patient should be
exposed from the waist up for this examination therefore you may wish to offer
a chaperone

 Wash your hands

 Introduce yourself to the patient

As you have been given a fairly directed instruction, there is little observation to
be done. As the station however revolves around examination of parts of the
immune system, it may look good to comment on the patient’s general
appearance and well-being initially.

 Perform a general inspection

Inspection
 lymphedema
 surgical scars from cancer excision
 obvious masses

Palpation

Begin with an examination of the lymph nodes which are arranged in various

groups. This should be done with the patient sitting and you standing behind
them. Feel both sides together for comparison.

Start under the chin to feel the submental node, then move along the lower
jaw line to feel the submandibular nodes. Then feel along the anterior border
of the sternocleidomastoid muscle for the anterior chain and around to the
posterior border for the posterior chain. Feel at the occiput for the occipital
nodes and then behind and in front of the ear for the post- and pre-auricular
nodes.

 Palpate the submental lymph nodes

 Palpate the submandibular lymph nodes

  Palpate the occipital lymph nodes

 Palpate the pre-auricular lymph nodes

 Palpate the post-auricular lymph nodes

 Palpate the cervical lymph nodes

Feel above and below the clavicle for the supra- and infra-clavicular nodes, and in
the axilla for the axillary nodes. For the axillary nodes it is best to have the
patient lying down with the back of the bed raised to 30 – 45 degrees. When
examining the right axilla take the weight of their right arm with your right arm
and examine with your left hand. You may wish to put gloves on for this
inspection.

If you notice any enlarged nodes, nodes with strange consistency, or fixed or
tender nodes; you should report this to the examiner.  Typically rubbery, non-
 tender nodes tend to be suspicious.  You should mention to the examiner at
this point you would also like to check the inguinal lymph nodes for
completion, although you usually won’t be expected to perform this.

Next you should move onto examine the liver and spleen. Palpation for the liver
and spleen is similar, both starting in the right iliac fossa.

For the liver, press upwards towards the right hypochondrium. You should try
to time the palpation with the patient breathing in as this presses down on the
liver. If nothing is felt you should move towards the costal margin and try
again. A distended liver feels like a light tap on the leading finger when you
press down. If the liver is distended, its distance from the costal margin should
be noted.

 Palpate for the liver

 Front of abdomen

Palpating for the spleen is as for the liver but in the direction of the left
hypochondrium. The edge of the spleen which may be felt if distended, is
more nodular than the liver. Another way to assess for splenomegaly is to ask
the patient to lie on their right side. Support the rib cage with your left hand
and again ask the patient to take deep breaths in moving your right hand up
towards the left hypochondrium.
  Palpating for the spleen

Thank your patient and allow them to dress. Report any findings to your
examiner.