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 four cardinal signs of hypersplenism, the other three being cytopenia(s), normal or hyperplastic bone marrow, and a response to splenectomy. 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. Thus, the finding of an enlarged spleen; along with caput medusa; is an important sign of portal hypertension.

Normal spleen

Definition

Splenomegaly is defined as spleen size > 12 cm.^{[citation needed]} Poulain et al. calssify splenmegaly as : 1-Moderate splenomegaly, if the largest dimension is between 11-20 cm 2-Severe splenomegaly , if the largest dimension is greater than 20 cm

Symptoms and signs

Symptoms may include abdominal pain, back 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

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

• thalassemia
• visceral leishmaniasis (Kala Azar)
• schistosomiasis
• chronic myelogenous leukemia
• chronic lymphocytic leukemia
• lymphomas
• hairy cell leukemia
• myelofibrosis
• polycythemia vera
• Gauchers disease
• Niemann Pick disease
• 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^{[citation needed]}.

See also

• sign (medicine)
• Hepatosplenomegaly
• Splenic infarction

References

1. ^ Grover SA, Barkun AN, Sackett DL (1993). "The rational clinical examination. Does this patient have splenomegaly?". JAMA 270 (18): 2218–21. doi:10.1001/jama.270.18.2218. PMID 8411607.  Ovid full text

External links

• PatientPlus Splenomegaly and hypersplenism
• Medical dictionary
• 11-141b. at Merck Manual of Diagnosis and Therapy Professional Edition (Hypersplenism)