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Splenomegaly
	Classification and external resources
ICD-10	Q89.0, R16.1
ICD-9	759.0, 789.2
DiseasesDB	12375
MedlinePlus	003276
eMedicine	ped/2139 med/2156
MeSH	D013163

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 four cardinal signs of hypersplenism, the other three being cytopenia(s), normal or hyperplastic bone marrow, and a response to splenectomy. 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 infiltration by leukemias and lymphomas. Thus, the finding of an enlarged spleen; along with caput medusa; is an important sign of portal hypertension.

Normal spleen

[edit] Definition

Splenomegaly is defined as spleen size > 12 cm.^{[citation needed]} Poulain et al. calssify splenmegaly as : 1-Moderate splenomegaly, if the largest dimension is between 11-20 cm 2-Severe splenomegaly , if the largest dimension is greater than 20 cm

[edit] Symptoms and signs

Symptoms may include abdominal pain, back pain, early satiety due to splenic encroachment, or the symptoms of anemia due to accompanying cytopenia.

Signs of splenomegaly may include a palpable left upper quadrant abdominal mass or splenic rub. It can be detected on physical examination by using Castell's sign or Traube's space, but an ultrasound can be used to confirm diagnosis.^[1]

[edit] Causes

Splenomegaly grouped on the basis of the pathogenic mechanism
Increased function	Abnormal blood flow	Infiltration
Removal of defective RBCs spherocytosis thalassemia 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 Autoimmune 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 Alpha-mannosidosis Hurler syndrome and other Mucopolysaccharidoses Amyloidosis Tangier disease Benign and malignant infiltrations Leukemias(acute,chronic,lymphoid and myeloid) lymphomas(Hodgkins and non-hodgkins) myeloproliferative disorders metastatic tumors(commonly melanoma) histiocytosis X Hemangioma,lymphangioma splenic cysts hamartomas eosinophilic granuloma

The causes of massive splenomegaly (>1000 g) are much fewer and include:

[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, Streptococcus pneumoniae, and Meningococcus. They should also receive annual influenza vaccinations. Long-term prophylactic antibiotics may be given in certain cases.

[edit] See also

[edit] References

^ Grover SA, Barkun AN, Sackett DL (1993). "The rational clinical examination. Does this patient have splenomegaly?". JAMA 270 (18): 2218–21. doi:10.1001/jama.270.18.2218. PMID 8411607. Ovid full text

[edit] External links

PatientPlus Splenomegaly and hypersplenism
Medical dictionary
11-141b. at Merck Manual of Diagnosis and Therapy Professional Edition (Hypersplenism)

[pmid8411607-0] Grover SA, Barkun AN, Sackett DL (1993). "The rational clinical examination. Does this patient have splenomegaly?". JAMA 270 (18): 2218–21. doi:10.1001/jama.270.18.2218. PMID 8411607. Ovid full text

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