Q: What is the most essential first step for the examination of spleen?


Answer: Not always appreciated but the most important and first step in the exam of spleen is the relaxation of the examiner's hands. If examiners' hand is not relaxed and sudden pressure is applied, patient may feel unbearable pain and further examination may become difficult. Examiner should first put his hands softly after explaining to patient and let patient acclimatize to hands.  

Also, by placing patient gently in the right lateral decubitus position (+/-), with knees and neck flexed may make exam easy. This helps to rotate the spleen to a more anterior position.