Splenomegaly
Splenomegaly
Classification and external resources
ICD-10 Q89.0, R16.1
ICD-9 759.0, 789.2
DiseasesDB 12375
MedlinePlus 003276
eMedicine ped/2139 med/2156
MeSH D013163

Splenomegaly is an enlargement of the spleen. The spleen usually lies in the left upper quadrant (LUQ) of the human abdomen. It is one of the four cardinal signs of hypersplenism, some reduction in the number of circulating blood cells affecting granulocytes, erythrocytes or platelets in any combination; a compensatory proliferative response in the bone marrow; and the potential for correction of these abnormalities by 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

Contents

Definition

Splenomegaly is defined by Dr Abdul Ghaffar as spleen size >12 cm, as measured by ultrasound along its longer dimension.[citation needed]
Poulain et al. classify splenomegaly as:

  • Moderate splenomegaly, if the largest dimension is between 11–20 cm
  • Severe splenomegaly, if the largest dimension is greater than 20 cm

Splenomegaly should not be confused with hypersplenism. The former is a statement about the size of the spleen, and the latter about the spleen's function: these may coexist, or they may not. clinically if a spleen is palpable means it is enlarged as it has to undergo enlargement by at least two folds for being palpable. However tip of the spleen may be palpable in a newborn baby upto 3 months of age.

Symptoms and signs

Symptoms may include abdominal pain, chest pain, chest pain similar to pleuritic pain when stomach, bladder or bowels are full, 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 most common causes of splenomegaly in developed countries are infectious mononucleosis, splenic infiltration with cancer cells from a hematological malignancy and portal hypertension (most commonly secondary to liver disease) Also by Bacterial infections, such as syphilis or an infection of the heart's inner lining (endocarditis).[2]

Splenomegaly grouped on the basis of the pathogenic mechanism
Increased function Abnormal blood flow Infiltration
Removal of defective RBCs

Immune hyperplasia

Response to infection (viral, bacterial, fungal, parasitic)

Disordered immunoregulation

Extramedullary hematopoiesis

Organ Failure

Vascular

Infections

Metabolic diseases

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
  • littoral cell angioma

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

Treatment

If the splenomegaly underlies hypersplenism, a splenectomy is indicated and will correct the hypersplenism. However, the underlying cause of the hypersplenism will most likely remain, so a thorough diagnostic workup is still indicated, as leukemia, lymphoma, and other serious disorders can cause hypersplenism and splenomegaly. After splenectomy, however, patients have an increased risk for infectious diseases.

Patients undergoing splenectomy should be vaccinated against Haemophilus influenzae, Streptococcus pneumoniae, and Meningococcus. They should also receive annual influenza vaccinations. Long-term prophylactic antibiotics may be given in certain cases.

See also

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
  2. ^ Kaiser, Larry R.; Pavan Atluri; Giorgos C Karakousis; Paige M Porrett (2006). The surgical review: an integrated basic and clinical science study guide. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-5641-3. 

External links


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Look at other dictionaries:

  • splenomegaly — enlargement of the spleen, 1900, from spleno , comb. form of Gk. splen (see SPLEEN (Cf. spleen)) + megas great (fem. megale; see MICKLE (Cf. mickle)) …   Etymology dictionary

  • splenomegaly — [splē΄nə meg′ə lē, splen′əmeg′ə lē] n. [ModL: see SPLENO , MEGALO & Y3] enlargement of the spleen …   English World dictionary

  • splenomegaly — /splee neuh meg euh lee, splen euh /, n. Pathol. enlargement of the spleen. Also, splenomegalia /splee noh meuh gay lee euh, gayl yeuh, splen oh /. [1895 1900; SPLENO + MEGALY] * * * ▪ pathology       enlargement of the spleen, the abdominal… …   Universalium

  • splenomegaly —    For practical purposes a term interchangeable with splenitis, since neither will have the usual symptoms associated with inflammation. Splenomegaly is often associated with viral hepatitis, mononucleosis, typhoid fever and abnormally high… …   Herbal-medical glossary

  • splenomegaly — noun (plural lies) Etymology: International Scientific Vocabulary Date: circa 1900 abnormal enlargement of the spleen …   New Collegiate Dictionary

  • splenomegaly — noun An enlargement of the spleen …   Wiktionary

  • Splenomegaly — Enlargement of the spleen. * * * spleno·meg·a·ly .splen ō meg ə lē n, pl lies abnormal enlargement of the spleen * * * n. enlargement of the spleen. It most commonly occurs in malaria, schistosomiasis, and other disorders caused by parasites; in… …   Medical dictionary

  • splenomegaly — n. abnormal enlargement of the spleen (Medicine) …   English contemporary dictionary

  • splenomegaly — [ˌspli:nə(ʊ) mɛg(ə)li] noun abnormal enlargement of the spleen. Origin early 20th cent.: from splen + Gk megas, megal great …   English new terms dictionary

  • splenomegaly — spleno·meg·a·ly …   English syllables

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