SPLENOMEGALY

'Splenomegaly' is an enlargement of the spleen, which usually lies in the left upper quadrant (LUQ) of the human abdomen. It is one of the cardinal signs of hypersplenism. Splenomegaly is usually associated with increased workload (such as in hemolytic anemias), which suggests that it is a response to hyperfunction. It is therefore not surprising that splenomegaly is associated with any disease process that involves abnormal red blood cells being destroyed in the spleen. Other common causes include congestion due to portal hypertension and infiltration by leukemias and lymphomas.

Contents

Symptoms and signs

Causes

Treatment

See also

References

External links

Symptoms and signs

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]

Causes

'Splenomegaly grouped on the basis of the pathogenic mechanism'

Increased function	Abnormal blood flow	Infitration
'''Removal of defective RBCs'''Spherocytosis Thalassemia Hemoglobinopathies Nutritional anemias early sickle cell anemia '''Immune hyperplasia''' ''Response to infection (viral,bacterial,fungal,parasitic'') Mononucleosis, AIDS, viral hepatitis subacute bacterial endocarditis, bacterial septicemia splenic abscess, typhoid fever brucellosis, leptospirosis, tuberculosis histoplasmosis malaria, leishmaniasis, trypanosomiasis ehrlichiosis ''Disordered immunoregulation'' Rheumatoid arthritis SLE Serum sickness Autoimmune hemolytic anemia Immune thrombocytopenia sarcoidosis drug reactions '''Extramedullary hematopoiesis''' Myelofibrosis Marrow infiltration by tumors, leukemias marrow damage by radiation, toxins	'''Organ Failure''' Cirrhosis congestive heart failure '''Vascular''' hepatic vein obstruction portal vein obstruction Budd-Chiari syndrome splenic vein obstruction '''Infections''' hepatic schistosomiasis hepatic echinococcosis	'''Metabolic diseases''' Gauchers disease Niemann-Pick disease Hurler syndrome and other Mucopolysaccharidoses Amyloidosis Tangier disease '''Benign and malignant infiltrations''' Leukemias(acute,chronic,lymphoid and myeloid) lymphomas(Hodgkins and non-hodgkins) myeloproliferative disorders metastatic tumors(commonly melanoma) histiocytosis X Hemangioma,lymphangioma splenic cysts hamartomas eosinophilic granuloma

The causes of massive splenomegaly (>1000gms) are much fewer and include:

Chronic myelogenous leukemia
lymphomas
hairy cell leukemia
myelofibrosis
polycythemia vera
Gauchers disease
chronic lymphocytic leukemia
sarcoidosis
autoimmune hemolytic anemia
Malaria

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.

See also

★ sign (medicine)

★ Hepatosplenomegaly

References

1. The rational clinical examination. Does this patient have splenomegaly?, Grover SA, Barkun AN, Sackett DL, , , JAMA, 1993 Ovid full text

External links

★ PatientPlus Splenomegaly and hypersplenism

★ (Hypersplenism)