Related Subjects:
|Cardiology Examination
|Cardiology History Taking
|Epstein-Barr Virus infection
| Cytomegalovirus (CMV) infections
The commonest cause of splenomegaly in the western world will be a viral infections, such as mononucleosis
Aetiology
- Extramedullary haemopoiesis with myeloproliferative disease
- Increased reticuloendothelial activity in haemolytic anaemia
- Enlarges with Infiltrative and storage disease
Introduction (Use the acronym WIPER to prepare for the examination)
- W - Wash your hands
- I - Introduce yourself and confirm patient details
- P - Permission - gain consent to proceed with the examination, including explaining relevant details
- E - Expose the patient appropriately, gather Equipment
- R - Position the patient lying back at 45 degrees comfortably
- Evaluation of splenomegaly is difficult and easy to miss
- The spleen enlarges from left hypochondrium towards the RLQ.
- Palpation During the Spleen Exam
- Start in RLQ just so you don’t miss a giant spleen
- Get your fingers set then ask patient to take a deep breath
- Don’t dip your fingers or do anything but wait.
- When patient breathes out move fingers a few cms towards left hypochorndum and repeat. Let the pleen come to you and not the other way round
- If you feel the edge of the spleen appreciate the splenic contour, and tenderness. If spleen is not felt, repeat with pt lying on right side. Gravity may bring spleen within reach. be gentle as an enlarghed sleep even with IM can be fragile.
- Percussion
- Precuss from the RLQ to the Right hypocnhdrium
- Any dullness (bowel is resonant) suggests spleen or rarely gastric/colonic content
- Characteristics of Spleen
- Has a notch
- Superfical
- Dull to percussion
- Cannot get hand between ribs and spleen
- It moves with respiration
- Finishing
- Thank patient and offer to help patient get dressed
- Wash hands and think about how to present your findings
- Present Findings and suggest a differential diagnosis
- Suggests appropriate investigations and management
Diagram showing the direect the spleen enlargement
Causes
- Hepatosplenomegaly
- Myeloproliferative disease
- Myelofibrosis (often massive)
- Polycythaemia vera
- Lymphoproliferative disease
- Infiltration e.g. amyloid
- Liver disease e.g. cirrhosis
- Splenomegaly
- Haematology Malignancy
- Chronic Myeloid Leukaemia (Massive)
- Myelofibrosis (Massive)
- Infections
- Malaria (Massive)
- Visceral leishmaniasis (kala-azar) (Massive)
- Mild/moderate splenomegaly
- Portal hypertension
- Abnormal Hb
- Thalassaemia
- Haemolytic anaemias
- Haematology Malignancy
- Lymphoma
- Acute and Chronic Leukaemia
- Polycythaemia Vera
- Rheumatology
- Rhematoid arthritis
- Systemic lupus erythematosis
- Polyarteritis nodosa
- Infiltrative
- Amyloid, Sarcoid
- Storage disease - Gaucher's and Niemann Pick
- Infections
- Viral, e.g. infectious mononucleosis, EBV and CMV
- Bacterial (any bacteria), occasionally – remember infective endocarditis
- Protozoal, e.g. malaria, kala-azar
Investigations
- FBC shows hypersplenism
- Splenomegaly +
- Pancytopenia +
- Normal or hypercellular bone marrow.
- USS/CT scan shows enlarged spleen
- Biopsy of lymph nodes
- CXR
- FBC - hypersplenism
- Bone marrow exam
- Exclude infectious disease
Management
- Splenectomy in selected cases