Reticulo-Endothelial Examination

Whilst this may sound like a daunting name for a station, it is actually fairly basic, and one in which you should aim to pick up a good mark. Reticulo-Endothelial is typically a medical way of saying “Examine the lymph nodes, liver and spleen”.

Subject steps

1. 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.

2. 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.

   The cervical, supraclavicular, infraclavicular, and axillary nodes should all be felt.

   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.

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3. 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 and raise their arm above their head. You may wish to put gloves on for this inspection.

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4. 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 axillary and inguinal lymph nodes for completion, although you usually won't be expected to perform this.

5. 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.

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6. 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.

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