Josh is a 14-year-old boy who presents with a sore throat. on examination, you notice dullness in the last intercostal space in the anterior axillary line on his left side with a deep breath. what does this indicate?

Josh's spleen may be enlarged. Further examination will be needed and close attention should be given.

Splenomegaly means that there is an underlying medical illnesses such as cancers, liver diseases, inflammatory diseases, infiltrated diseases, trauma or infections. To resolve splenomegaly, the underlying cause must be treated.

1. loamy sand is about 80% sand with 10% clay and defined mostly by sand particles with some clay to provide structure and fertility. the sand particles are easily visible and the soil holds structure but breaks apart easily.

2. scott sand can improve his soil quality by incorporating more silt and organic matter into the soil. peat moss and organic matter can also be incorporated.