Splenomegaly: Difference between revisions

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Line 34: Line 34:
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fatigue
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fatigue
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Weight loss
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Weight
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bleeding
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bleeding
Line 43: Line 43:
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |CBC
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |CBC
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |PS
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Iron
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Iron
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |LFT
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |LFT
Line 49: Line 48:
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |BUN/Cr
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |BUN/Cr
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |UA
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |UA
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |WBC
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |WBC
Line 57: Line 57:
! colspan="2" align="center" style="background:#DCDCDC;" |[[Cirrhosis]]
! colspan="2" align="center" style="background:#DCDCDC;" |[[Cirrhosis]]
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |Any
* Infection
* Alcohol
* Autoimmune
| align="center" style="background:#F5F5F5;" |Any, more in elderly
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* [[Hepatitis]]
* [[Hepatitis]]
* [[Alcoholism|Alcohol use]]
* [[Alcoholism|Alcohol use]]
| align="center" style="background:#F5F5F5;" | -
* [[Non-alcoholic fatty liver disease|NAFLD]]
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |↑↓
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |+
| align="center" style="background:#F5F5F5;" |+
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Spider angiomata
* Palmar erythema
* Weakness
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Dark urine
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Pancytopenia
* Regenerating nodules of hepatocytes
* Fibrosis
* Deposition of connective tissue between these nodules
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Small and nodular liver on ultrasound
* Fibrosis on liver scan
| align="center" style="background:#F5F5F5;" |Liver biopsy
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Hepatic encephalopathy
| align="center" style="background:#F5F5F5;" |
* Gynecomastia
| align="center" style="background:#F5F5F5;" |
* Hypogonadism
| align="center" style="background:#F5F5F5;" |
* Esophageal varices
| align="center" style="background:#F5F5F5;" |
* Caput medusa
| align="center" style="background:#F5F5F5;" |
* Dupuytren's contracture
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
|-
! colspan="2" align="center" style="background:#DCDCDC;" |[[Congestive heart failure|Heart failure]]
! colspan="2" align="center" style="background:#DCDCDC;" |[[Congestive heart failure|Heart failure]]
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Coronary artery disease
* HTN
| align="center" style="background:#F5F5F5;" |Elderly
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Smoking
* Sedentary lifestyle
* Obstructive sleep apnea
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |↑↓
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |±
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Dyspnea
* Weakness
* Chest pain
* Heart murmur
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Normal or low ejection fraction on echocardiography
* Cardiomegaly on chest xray
| align="center" style="background:#F5F5F5;" |Echocardiography
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Pulmonary edema
| align="center" style="background:#F5F5F5;" |
* Hyponatremia
| align="center" style="background:#F5F5F5;" |
* Elevated BNP
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
|-
! colspan="2" align="center" style="background:#DCDCDC;" |[[Thrombosis]] of [[portal]], [[Liver|hepatic]], or [[Splenic vein|splenic veins]]
! colspan="2" align="center" style="background:#DCDCDC;" |[[Thrombosis]] of [[portal]], [[Liver|hepatic]], or [[Splenic vein|splenic veins]]
Line 373: Line 406:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hb
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hb
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Plt
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Plt
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |PS
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Iron
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Iron
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |LFT
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |LFT
Line 379: Line 411:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |BUN/Cr
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |BUN/Cr
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |UA
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |UA
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard
Line 838: Line 871:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hb
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hb
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Plt
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Plt
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |PS
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Iron
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Iron
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |LFT
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |LFT
Line 844: Line 876:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |BUN/Cr
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |BUN/Cr
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |UA
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |UA
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard
Line 1,111: Line 1,144:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hb
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hb
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Plt
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Plt
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |PS
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Iron
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Iron
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |LFT
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |LFT
Line 1,117: Line 1,149:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |BUN/Cr
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |BUN/Cr
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |UA
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |UA
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard

Revision as of 18:33, 27 September 2018

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List of terms related to Splenomegaly

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Gichoya Judy Wawira [2], Moi University School of Medicine

Synonyms and keywords: Spleen enlargement; enlarged spleen; spleen swelling

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Splenomegaly from Other Diseases

Category Disease Etiology Clinical manifestations Para−clinical findings Gold standard Associated findings
Demography History Symptoms Signs Lab Findings Imaging
Fever Fatigue Weight Abdominal pain Bleeding BP JVP Jaundice Ascites Other CBC Iron LFT PT/PTT BUN/Cr UA Histopathology
WBC Hb Plt
Congestive Cirrhosis
  • Infection
  • Alcohol
  • Autoimmune
 Any, more in elderly – + ↑↓ + + ↓ Nl + +
  • Spider angiomata
  • Palmar erythema
  • Weakness
 ↓ ↓ ↓ Nl ↑ ↑ ↑ Dark urine
  • Pancytopenia
  • Regenerating nodules of hepatocytes
  • Fibrosis
  • Deposition of connective tissue between these nodules
  • Small and nodular liver on ultrasound
  • Fibrosis on liver scan
 Liver biopsy
  • Hepatic encephalopathy
  • Gynecomastia
  • Hypogonadism
  • Esophageal varices
  • Caput medusa
  • Dupuytren's contracture
Heart failure
  • Coronary artery disease
  • HTN
 Elderly
  • Smoking
  • Sedentary lifestyle
  • Obstructive sleep apnea
 – + ↑↓ – – ↑ ↑ ± +
  • Dyspnea
  • Weakness
  • Chest pain
  • Heart murmur
 ↓ ↓ ↑ Nl ↑ ↑ ↑ Nl NA
  • Normal or low ejection fraction on echocardiography
  • Cardiomegaly on chest xray
 Echocardiography
  • Pulmonary edema
  • Hyponatremia
  • Elevated BNP
Thrombosis of portal, hepatic, or splenic veins
Malignancy Lymphoma
Leukemia
Polycythemia Vera
Multiple myeloma
Essential thrombocythemia
Primary myelofibrosis
Primary splenic tumors
Metastatic solid tumors
Category Disease Etiology Demography History Fever Fatigue Weight loss Abdominal pain Bleeding BP JVP Jaundice Ascites Other WBC Hb Plt Iron LFT PT/PTT BUN/Cr UA Histopathology Imaging Gold standard Associated findings
Infection Viral Hepatitis
Infectious mononucleosis
Cytomegalovirus
Bacterial Salmonella
Brucella
Tuberculosis
Parasitic Malaria
Schistosomiasis
Toxoplasmosis
Kala-azar Visceral leishmaniasis
Infective endocarditis
Fungal
Inflammation Sarcoidosis
Serum sickness
Systemic lupus erythematosus
Felty syndrome
Category Disease Etiology Demography History Fever Fatigue Weight loss Abdominal pain Bleeding BP JVP Jaundice Ascites Other WBC Hb Plt Iron LFT PT/PTT BUN/Cr UA Histopathology Imaging Gold standard Associated findings
Infiltrative Gaucher disease
Niemann-Pick disease
Amyloidosis
Langerhans cell histiocytosis
Hemophagocytic lymphohistiocytosis
Rosai-Dorfman disease
Hematologic (hypersplenic) states Hemolytic anemia
Sickle cell disease
Granulocyte colony-stimulating factor
Category Disease Etiology Demography History Fever Fatigue Weight loss Abdominal pain Bleeding BP JVP Jaundice Ascites Other WBC Hb Plt Iron LFT PT/PTT BUN/Cr UA Histopathology Imaging Gold standard Associated findings

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Diagnosis

Treatment

Case Studies

Case #1

Related Chapters

References

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