A wide variety of diseases are associated with splenomegaly, or enlargement of the spleen, with many of the mechanisms leading to this condition being exaggerated forms of normal spleen function. Hypersplenism is a secondary process that can arise from splenomegaly of almost any cause see table common causes of splenomegaly. Splenomegaly, hypersplenism, and hereditary disorders with. We speculate that the clinical and pathological sequelae attributable to the e3. Splenomegaly, hypersplenism, and hereditary disorders with splenomegaly. You think that he is depressed but want to rule out infectious mononucleosis and decide to examine him for splenomegaly. The term splenomegaly does not imply a particular cause of this enlargement, and as in other species, a range of potential causes should be considered in each case synonyms. Evaluation of splenomegaly approach bmj best practice. Sonographically, 52% of patients had a definitely large spleen and 35% a spleen less than one standard deviation from the normal.
This study confirms that physical examination is inaccurate in detecting splenomegaly in hivpositive patients, although accuracy improved when techniques were combined. Hypersplenism hematology and oncology merck manuals. Abdominal examination osce guide new release youtube. Splenomegaly general presentation the spleen is a hematopoietic organ supporting the megakaryotic, lymphoid, erythroid, myeloid, and reticuloendothelial systems.
Comparing physical examination with sonographic versions. The splenomegaly diagnosis code was considered valid if one of the following criteria was met. Clinical approach to isolated splenomegaly association physicians. Spleen becomes enlarged in many disease processes the aetiology ranging from infections to neoplasms such as cml.
During two evaluations of refugee populations in western uganda in march and july 2015, refugees with splenomegaly on physical examination were offered additional assessment and treatment, including abdominal ultrasonography and laboratory testing. Ct and mri may provide more detail of the organs consistency. Always adhere to your medical schoollocal hospital guidelines when performing examinations or clinical procedures. Spleen spleen is a reticuloendothelial organ that arises in the dorsal mesogastrium at about 5 weeks gestation. The second is a college student with failing appetite, ability to concentrate, energy, and grades. Its vascularity, location, and functions make the spleen susceptible to several conditions that may be challenging to evaluate and treat. Physical examination is the most practical and cost effective method of evaluation of splenomegaly4. Spleen exam stanford medicine 25 stanford medicine. Evaluation of splenomegaly differential diagnosis of. The spleen is enlarged in a number of important clinical diagnoses. The spleen usually lies in the left upper quadrant luq of the human abdomen. Prevalence and clinical significance of splenomegaly in.
Splenomegaly and hypersplenism information page patient. Population for whom the physical examination of splenomegaly should be sought. American physiological society, american society for clinical investigation, american society of. Mri is especially useful in detecting portal or splenic vein thromboses. If confirmation of splenomegaly is necessary because the examination is equivocal, ultrasonography is the test of choice because of its accuracy and low cost. How do you differential the spleen from the kidney on abdominal examination. Palpation and percussion of the spleen are important techniques for identifying an enlarged. Splenomegaly may be noted incidentally on physical exam or on imaging, or as a.
Splenomegalyan insensitive sign of portal hypertension. Erythema nodosum and lupus pernio may be seen in sarcoidosis. Clinical examination of spleen jibran mohsin resident, surgical unit i simsservices hospital, lahore 2. Pdf to find out the relative frequency of clinical conditions associated with splenomegaly that require hematological evaluation in our set up. Symptoms are seldom caused by the size of the spleen directly, but rather due to its hematologic effects on the different cell lines, which manifest as anemia, leucopenia, thrombocytopenia, or as a combination of these i. Palpation and percussion of the spleen are important techniques for identifying an enlarged spleen. Unusual case of severe hypertriglyceridemia and splenomegaly. A person with splenomegaly should take care to avoid all contact sports and any other activities that could potentially deliver a hard impact to their abdomen. Physical examination of the spleen is performed with the. The third is an otherwise healthy, wellcontrolled, hypertensive male with a normal cardiovascular examination. Do not perform any examination or procedure on patients based purely upon the. Patients with splenomegaly due to acute infection may present. Cutaneous infection may be evident on clinical exam and can occur in leukemias.
It is a reservoir for platelets and a site for the proliferation of blymphocytes. An overzealous palpation of the abdomen or a sudden blow can split the outer capsule of the spleen and cause bleeding into the abdominal cavity. Hypersplenism is a clinical syndrome characterized by. Moreover, the examination should start with traube space percussion, followed, if dull, by supine 1handed palpation. At 9 months she presented to her general practitioner with an upper respiratory infection. Splenomegaly is an exception rather than the rule, and the hematologic profile is that of selective absence or reduction in the number of neutrophils, while monocytes, eosinophils, and basophils are either normal or increased. Following a referral to the local haematology services a bone marrow aspiration was performed that revealed foam. Examination of post nasal space in cervical lymh adenopathy. Splenomegaly causes of splenomegaly portal hypertension 33% chronic liver disease portalsplenic venous obstruction. Pdf the detection of an enlarged spleen is important in clinical diagnosis. Splenomegaly was defined by ultrasound as a spleen with a long axis. To determine whether sonographic versions of physical examination techniques can accurately identify splenomegaly, castells method ann intern med 1967. Spleen is supplied by the splenic artery and drains into portal circulation via the splenic vein. Clinical assessment begins with a thorough history and exami nation.
The findings of different examiners seem to vary widely and in this study, accuracy was not associated with clinical experience. Clinically palpable spleen by abdominal examination on two occasions or by two physicians on the same occasion. The history may elicit symptoms of pressure effects from the enlarged spleen, such as left. Pointofcare ultrasonography significantly improved the sensitivity of physical examination alone in diagnosing splenomegaly in a prospective study of 39 adult hospitalized patients. Outline introduction clinical examination inspection palpation percussion features of splenic mass 3. Clinical examination and routine laboratory tests are done every 3 months during the. Although several methods of palpation and percussion of the spleen have been described, until recently they have not been validated by noninvasive imaging techniques such as ultrasonography, radionuclide scanning, and computed tomography that offer objective means to assess splenomegaly. Sociodemographic data and laboratory values were extracted from the shcs database and from patients charts. Prednisone plus chloroquine for the treatment of hyperreactive malarial splenomegaly lihms. It spans from the 9th to 11th rib and weighs between 150200g. However, it may also refer to an enlarged spleen detected by an imaging test. Thorough clinical examination and investigations will generally. It enlarges towards the right iliac fossa rif always start palpation in the rif and move across towards the right upper quadrant or a massive splenomegaly may be missed.
Splenomegaly is one of the four cardinal signs of hypersplenism which include. Splenomegaly knowledge for medical students and physicians. Prednisone plus chloroquine for the treatment of hyper. Pdf hematological evaluation of splenomegaly researchgate. Assessing for the presence of splenomegaly is an important component of the physical examination. Pdf reliability of clinical techniques for detecting splenic. The spleen is a highly vascular organ that participates in hematologic and immune homeostasis.
Massive splenomegaly was the only prominent feature on clinical examination and on subsequent imaging. Isolated splenomegaly as the presenting feature of niemann. Comparing physical examination with sonographic versions of the. Xanthelasma is found early in pbc, whereas skin thinning and muscle mass loss occur late. Visit our research pages for current research about splenomegaly treatments clinical trials for splenomegaly. Splenomegaly may be a presenting or dominant feature of certain diseases. The presence of an enlarged spleen can be more precisely. In cases in which splenomegaly is questioned, the clinical examination is more specific than sensitive and is best used when ruling in the diagnosis among patients for whom the suspicion is at least 10%. Hypersplenism is a clinical syndrome characterized by splenomegaly, pancytopenia or reduction in the number of one or more types of blood cells, neutropenia is less common than anemia and. A splenic edge felt more than 2 cm below the left costal margin is abnormal.
When considering whether an luq mass is an enlarged spleen, features of an enlarged spleen include that. Splenomegaly hematology and oncology merck manuals. Other functions include filtering senescent and defective red blood cells, presenting antigens to the immune system, and destroying. The spleen is a secondary lymphoid organ that lies in intraperitoneally in the left hypochondrium, abuting the diaphragm.
Clinical events were recorded prospectively for 1 year after the examination to evaluate the clinical importance of splenomegaly. Complete history,clinical exam,presence and extent of adenopathy. Get a printable copy pdf file of the complete article 1. Splenomegaly increases the spleens mechanical filtering and destruction of red blood cells rbcs and often of white blood cells wbcs and platelets. It is a part of reticuloendothelial system, immune system and is. Anatomy develops from condensations of mesoderm in the dorsal mesogastrium. Splenomegaly can be found in 3% of the normal population. Request pdf splenomegaly splenomegaly is a common finding on clinical examination, and frequently features in postgraduate assessments. Evaluation of splenomegaly is notoriously difficult and embarrassingly easy to miss when present. Each patient was examined for splenomegaly using conventional. Common splenomegaly exam questions for medical finals, osces and mrcp paces.
A comparison with earlier case reports suggests that the dyslipidemia in e3. Splenomegaly is a nonspecific term that refers to diffuse enlargement of the spleen. Hypersplenism in patients with liver cirrhosis and portal. The etiology is diverse and may result from increased splenic activity, decreased venous drainage, or infiltration of the spleen. Prednisone plus chloroquine versus chloroquine for the treatment of hyperreactive malarial splenomegaly in papua new guinea. To determine whether sonographic versions of physical examination. The term splenomegaly generally denotes a palpably enlarged spleen.
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