Hypersplenism hematology and oncology merck manuals. 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. You think that he is depressed but want to rule out infectious mononucleosis and decide to examine him for splenomegaly. Splenomegaly causes of splenomegaly portal hypertension 33% chronic liver disease portalsplenic venous obstruction. Splenomegaly hematology and oncology merck manuals. 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. Spleen is supplied by the splenic artery and drains into portal circulation via the splenic vein. 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. Hypersplenism is a clinical syndrome characterized by. Its vascularity, location, and functions make the spleen susceptible to several conditions that may be challenging to evaluate and treat. Clinical assessment begins with a thorough history and exami nation. Erythema nodosum and lupus pernio may be seen in sarcoidosis. Following a referral to the local haematology services a bone marrow aspiration was performed that revealed foam. Palpation and percussion of the spleen are important techniques for identifying an enlarged.
The splenomegaly diagnosis code was considered valid if one of the following criteria was met. This study confirms that physical examination is inaccurate in detecting splenomegaly in hivpositive patients, although accuracy improved when techniques were combined. Examination of post nasal space in cervical lymh adenopathy. Splenic size was measured objectively via its cranio. 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. Clinical examination and routine laboratory tests are done every 3 months during the. Pdf reliability of clinical techniques for detecting splenic. Splenomegaly may be noted incidentally on physical exam or on imaging, or as a.
Sonographically, 52% of patients had a definitely large spleen and 35% a spleen less than one standard deviation from the normal. 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. How do you differential the spleen from the kidney on abdominal examination. 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. Splenomegaly is a nonspecific term that refers to diffuse enlargement of the spleen. The presence of an enlarged spleen can be more precisely. To determine whether sonographic versions of physical examination techniques can accurately identify splenomegaly, castells method ann intern med 1967.
Ct and mri may provide more detail of the organs consistency. Splenomegaly and hypersplenism information page patient. Unusual case of severe hypertriglyceridemia and splenomegaly. Population for whom the physical examination of splenomegaly should be sought. Evaluation of splenomegaly is notoriously difficult and embarrassingly easy to miss when present. Patients with splenomegaly due to acute infection may present. 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. 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. Clinical examination of spleen jibran mohsin resident, surgical unit i simsservices hospital, lahore 2.
Evaluation of splenomegaly differential diagnosis of. Comparing physical examination with sonographic versions. Splenomegaly can be found in 3% of the normal population. Physical examination of the spleen is performed with the. Since the spleen enlarges in many conditions, a systematic approach may facilitate timely and costeffective diagnosis of the cause of splenomegaly. The second is a college student with failing appetite, ability to concentrate, energy, and grades. Splenomegaly may be a presenting or dominant feature of certain diseases. Physical examination is the most practical and cost effective method of evaluation of splenomegaly4. Prednisone plus chloroquine for the treatment of hyper.
The spleen is a secondary lymphoid organ that lies in intraperitoneally in the left hypochondrium, abuting the diaphragm. Splenomegalyan insensitive sign of portal hypertension. 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. Hypersplenism is a secondary process that can arise from splenomegaly of almost any cause see table common causes of splenomegaly. Splenomegaly knowledge for medical students and physicians. The spleen is a highly vascular organ that participates in hematologic and immune homeostasis. 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%. Evaluation of splenomegaly approach bmj best practice.
Xanthelasma is found early in pbc, whereas skin thinning and muscle mass loss occur late. Splenomegaly is one of the four cardinal signs of hypersplenism which include. Cutaneous infection may be evident on clinical exam and can occur in leukemias. Prednisone plus chloroquine for the treatment of hyperreactive malarial splenomegaly lihms. Get a printable copy pdf file of the complete article 1. 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. The spleen is enlarged in a number of important clinical diagnoses. Spleen exam stanford medicine 25 stanford medicine. Splenomegaly, hypersplenism, and hereditary disorders with. Prevalence and clinical significance of splenomegaly in.
Pdf hematological evaluation of splenomegaly researchgate. It is a reservoir for platelets and a site for the proliferation of blymphocytes. Sociodemographic data and laboratory values were extracted from the shcs database and from patients charts. Superficial abdominal venous distention may be present when splenomegaly is a result of portal hypertension. Hypersplenism in patients with liver cirrhosis and portal. Thorough clinical examination and investigations will generally. Request pdf splenomegaly splenomegaly is a common finding on clinical examination, and frequently features in postgraduate assessments. Splenomegaly was defined by ultrasound as a spleen with a long axis. Other functions include filtering senescent and defective red blood cells, presenting antigens to the immune system, and destroying. Splenomegaly, hypersplenism, and hereditary disorders with splenomegaly. When considering whether an luq mass is an enlarged spleen, features of an enlarged spleen include that.
A splenic edge felt more than 2 cm below the left costal margin is abnormal. Massive splenomegaly was the only prominent feature on clinical examination and on subsequent imaging. If confirmation of splenomegaly is necessary because the examination is equivocal, ultrasonography is the test of choice because of its accuracy and low cost. The etiology is diverse and may result from increased splenic activity, decreased venous drainage, or infiltration of the spleen. Isolated splenomegaly as the presenting feature of niemann. Outline introduction clinical examination inspection palpation percussion features of splenic mass 3. Assessing for the presence of splenomegaly is an important component of the physical examination. Palpation and percussion of the spleen are important techniques for identifying an enlarged spleen. Clinical approach to isolated splenomegaly association physicians. At 9 months she presented to her general practitioner with an upper respiratory infection. The findings of different examiners seem to vary widely and in this study, accuracy was not associated with clinical experience. Pointofcare ultrasonography significantly improved the sensitivity of physical examination alone in diagnosing splenomegaly in a prospective study of 39 adult hospitalized patients. Common splenomegaly exam questions for medical finals, osces and mrcp paces. Do not perform any examination or procedure on patients based purely upon the.
Clinical events were recorded prospectively for 1 year after the examination to evaluate the clinical importance of splenomegaly. Each patient was examined for splenomegaly using conventional. Visit our research pages for current research about splenomegaly treatments clinical trials for splenomegaly. Anatomy develops from condensations of mesoderm in the dorsal mesogastrium. Splenomegaly symptoms, diagnosis, treatments and causes. It is a part of reticuloendothelial system, immune system and is. Mri is especially useful in detecting portal or splenic vein thromboses. The third is an otherwise healthy, wellcontrolled, hypertensive male with a normal cardiovascular examination. Always adhere to your medical schoollocal hospital guidelines when performing examinations or clinical procedures. A comparison with earlier case reports suggests that the dyslipidemia in e3. Complete history,clinical exam,presence and extent of adenopathy. Pdf the detection of an enlarged spleen is important in clinical diagnosis. Spleen spleen is a reticuloendothelial organ that arises in the dorsal mesogastrium at about 5 weeks gestation. Pdf to find out the relative frequency of clinical conditions associated with splenomegaly that require hematological evaluation in our set up.
Abdominal examination osce guide new release youtube. The term splenomegaly generally denotes a palpably enlarged spleen. To determine whether sonographic versions of physical examination. The spleen usually lies in the left upper quadrant luq of the human abdomen. American physiological society, american society for clinical investigation, american society of. Spleen becomes enlarged in many disease processes the aetiology ranging from infections to neoplasms such as cml. 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. Comparing physical examination with sonographic versions of the.
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