Splenomegaly

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**Splenomegaly**
*Classification & external resources*
ICD-10	R 16.1
ICD-9	789.2
DiseasesDB	12375
MedlinePlus	003276
eMedicine	ped/2139 med/2156
MeSH	C23.300.775.750

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 infitration by leukemias and lymphomas.

Signs of splenomegaly may include a palpable left upper quadrant abdominal mass or splenic rub. Patients may also be cytopenic. Patients with splenomegaly may present with abdominal pain, early satiety due to splenic encroachment, and may complain of the symptoms of anemia due to accompanying cytopenia. It can be detected by physicians on physical examination, but an ultrasound can be used to confirm diagnosis.^[1]

1 Causes
2 Treatment
3 See also
4 References
5 External links

[edit] Causes

Splenomegaly grouped on the basis of the pathogenic mechanism

Increased function	Abnormal blood flow	Infitration
Removal of defective RBCs Spherocytosis Thalasemia 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 Immune 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 Hurlers syndrome and other Mucopolysaccharidoses Amyloidosis Tangiers disease Benign and malignant infiltrations Leukemias(acute,chronic,lymphoid and myeloid) lymphomas(Hodgkins and non-hodgkins) myeloproliferative disorders metastatic tumors(commonly melanoma) histiocytosis X hemangiomas,lymphangiomas 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

[edit] 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.

[edit] See also

[edit] References

^ Grover S, Barkun A, Sackett D (1993). "The rational clinical examination. Does this patient have splenomegaly?". JAMA 270 (18): 2218-21. PMID 8411607.