Splenomegaly: Difference between revisions

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{{Splenomegaly}}
{{Splenomegaly}}
{{CMG}}; {{AOEIC}} Gichoya Judy Wawira [mailto:judywawira@gmail.com], Moi University School of Medicine
{{CMG}}; {{AOEIC}} Gichoya Judy Wawira [mailto:judywawira@gmail.com], Moi University School of Medicine
==Differential diagnosis of causes by organ system or pathogenesis==
'''Splenomegaly grouped on the basis of the pathogenic mechanism'''
{| class="wikitable"
|-
! Increased function
! Abnormal blood flow
! Infitration
|-
| '''''Removal of defective RBCs'''''
[[Spherocytosis]]<br />
[[Thalassemia]]<br />
[[Hemoglobinopathies]]<br />
Nutritional [[anemia]]s<br />
early [[sickle cell anemia]]<br />
'''''Immune hyperplasia'''''<br />
''Response to infection (viral,bacterial,fungal,parasitic'')<br />[[Mononucleosis]], [[AIDS]], [[viral hepatitis]]<br />subacute [[bacterial endocarditis]], bacterial [[septicemia]]<br /> splenic [[abscess]], [[typhoid fever]]<br />[[brucellosis]],[[ leptospirosis]], [[tuberculosis]]<br />[[histoplasmosis]]<br />[[malaria]], [[leishmaniasis]], [[trypanosomiasis]]<br />[[ehrlichiosis]]<br />''Disordered immunoregulation''<br />[[Rheumatoid arthritis]]<br />[[SLE]]<br />[[Serum sickness]]<br />[[Autoimmune hemolytic anemia]]<br />[[Idiopathic thrombocytopenic purpura|Immune thrombocytopenia]]<br />[[sarcoidosis]]<br />drug reactions<br />'''''Extramedullary hematopoiesis'''''<br />[[Myelofibrosis]]<br />Marrow infiltration by [[tumors]], [[leukemias]]<br />marrow damage by [[radiation]], [[toxins]]
|'''''Organ Failure'''''<br />
[[Cirrhosis]]<br />[[congestive heart failure]]<br />'''''Vascular'''''<br />[[hepatic vein obstruction]]<br />[[Portal vein thrombosis|portal vein obstruction]]<br />[[Budd-Chiari syndrome]]<br />[[splenic vein obstruction]]<br />'''''Infections'''''<br /><br />hepatic [[schistosomiasis]]<br />hepatic [[echinococcosis]]
|'''''Metabolic diseases'''''<br />[[Gauchers disease]]<br />[[Niemann-Pick disease]]<br />[[Hurler syndrome]] and other [[Mucopolysaccharidoses]]<br />[[Amyloidosis]]<br />[[Tangier disease]]<br />'''''Benign and malignant infiltrations'''''<br />[[Leukemias]](acute,chronic,lymphoid and myeloid)<br />lymphomas([[Hodgkins]] and [[Non-Hodgkin lymphoma|non-hodgkins]])<br />[[myeloproliferative]] disorders<br />[[metastatic]] tumors(commonly [[melanoma]])<br />[[histiocytosis X]]<br />[[Hemangioma]],[[lymphangioma]]<br />splenic [[cysts]]<br />[[hamartomas]]<br />[[eosinophilic granuloma]]
|}
<br />
The causes of massive splenomegaly (>1000gms) are much fewer and include:<br /><br />[[Thalassemia]]<br />[[Kala-Azar]] ([[Leishmaniasis]])<br />[[Portal hypertension]] of Bilharziasis<br />[[Chronic myelogenous leukemia]]<br />[[lymphomas]]<br />[[hairy cell leukemia]]<br />[[myelofibrosis]]<br />[[polycythemia vera]]<br />[[Gauchers disease]]<br />[[chronic lymphocytic leukemia]]<br />[[sarcoidosis]]<br />[[autoimmune hemolytic anemia]]<br />[[Malaria]]


==Clinical presentation==
==Clinical presentation==

Revision as of 20:09, 29 August 2012

Splenomegaly
Massively enlarged spleen, the result of extramedullary hematopoiesis, is outlined above. This patient's left upper quadrant appears more full than the corresponding area on the right.
Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California
ICD-10 Q89.0, R16.1
ICD-9 759.0, 789.2
DiseasesDB 12375
MedlinePlus 003276
MeSH D013163

Template: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

Clinical presentation

Symptoms may include abdominal pain, early satiety due to splenic encroachment, or the symptoms of anemia due to accompanying cytopenia.

Signs of splenomegaly may include a palpable left upper quadrant abdominal mass or splenic rub. It can be detected on physical examination by using Castell's sign or Traube's space, but an ultrasound can be used to confirm diagnosis.[1]


Treatment

If the splenomegaly underlies hypersplenism, a splenectomy is indicated and will correct the problem. After splenectomy, however, patients have an increased risk for infectious diseases.

After splenectomy, patients should be vaccinated against Haemophilus influenzae and Streptococcus pneumoniae. They should receive annual influenza vaccinations. Long-term prophylactic antibiotics should be given.

Related chapters

Resources

References

  1. ↑ Grover SA, Barkun AN, Sackett DL (1993). "The rational clinical examination. Does this patient have splenomegaly?". JAMA. 270 (18): 2218–21. PMID 8411607. Ovid full text

Template:Phakomatoses and other congenital malformations not elsewhere classified

Template:Skin and subcutaneous tissue symptoms and signs Template:Nervous and musculoskeletal system symptoms and signs Template:Urinary system symptoms and signs Template:Cognition, perception, emotional state and behaviour symptoms and signs Template:Speech and voice symptoms and signs Template:General symptoms and signs

de:Splenomegalie it:Splenomegalia


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