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splenomegaly

Enlargement of the spleen. Etiology: 1) massive splenomegaly a) Gaucher's disease b) myelofibrosis with myeloid metaplasia c) chronic myeloid leukemia d) portal hypertension - hepatic cirrhosis e) splenic cyst f) non-Hodgkin's lymphoma g) hairy cell leukemia h) chronic lymphocytic leukemia i) polycythemia rubra vera j) sarcoidosis k) autoimmune hemolytic anemia - common variable immunodeficiency 2) other causes a) extravascular hemolytic anemia b) amyloidosis c) extramedullary hematopoiesis d) autoimmune disorders - Felty syndrome e) non-autoimmune hemolytic anemia - Wilson's disease 3) also see causes of splenomegaly Pathology: 1) dilutional effect from expansion of plasma volume that accompanies splenomegaly 2) pooling of cells in spleen 3) serious bleeding or infectious complications are rare 5) splenomegaly itself does not cause increased destruction of normal cells Clinical manifestations: 1) dullness to percussion in Traube's space 2) may be painful 3) early satiety with massive splenomegaly Laboratory: 1) complete blood count (CBC) with peripheral smear - mild to moderate pancytopenia - platelet count is affected most 2) bone marrow aspiration & biopsy 3) chemistry panel a) liver function tests b) renal function tests * HgbA1c may be diminished if erythrocyte survival is reduced Special laboratory: - upper GI endoscopy to evaluate for esophageal varices if suspicion of portal hypertension & cirrhosis & in the context of alcohol abuse [5] Radiology: 1) computed tomography to evaluate anatomy of spleen [4] 2) ultrasound with doppler to evaluate flow through portal & splenic vein 3) technetium liver-spleen scan -> in chronic liver disease there is a redistribution of technetium from the liver to the bone marrow & spleen Management: -> splenectomy a) diagnosis if other diagnostic measures do not provide diagnosis b) therapeutic

Interactions

disease interactions

Related

causes of splenomegaly

Specific

hepatosplenomegaly

General

hypersplenism

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 45
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  3. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 350
  4. Veterans Administration, Dept of Radiology
  5. Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver Diseases. Hepatology. 2017;65:310-335. PMID: 27786365