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    Approach To Splenomegaly

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    Sarath Menon R
    Splenomegaly can have various causes that must be investigated through a step-wise approach including history, physical exam, lab tests, and imaging. The document outlines the evaluation of splenomegaly including defining associated features, investigating through tests such as CBC, blood smear, imaging like ultrasound and CT scan, and determining etiology through specialized testing in order to properly diagnose and treat the underlying condition.

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    Approach To Splenomegaly

    Uploaded by

    Sarath Menon R
    459 views37 pages
    Splenomegaly can have various causes that must be investigated through a step-wise approach including history, physical exam, lab tests, and imaging. The document outlines the evaluation of splenomegaly including defining associated features, investigating through tests such as CBC, blood smear, imaging like ultrasound and CT scan, and determining etiology through specialized testing in order to properly diagnose and treat the underlying condition.

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    splenomegaly-integrated approach to diagnosis

    Original Title

    Approach to Splenomegaly

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    Splenomegaly can have various causes that must be investigated through a step-wise approach including history, physical exam, lab tests, and imaging. The document outlines the evaluation of splenomegaly including defining associated features, investigating through tests such as CBC, blood smear, imaging like ultrasound and CT scan, and determining etiology through specialized testing in order to properly diagnose and treat the underlying condition.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    459 views37 pages

    Approach To Splenomegaly

    Uploaded by

    Sarath Menon R
    Splenomegaly can have various causes that must be investigated through a step-wise approach including history, physical exam, lab tests, and imaging. The document outlines the evaluation of splenomegaly including defining associated features, investigating through tests such as CBC, blood smear, imaging like ultrasound and CT scan, and determining etiology through specialized testing in order to properly diagnose and treat the underlying condition.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
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    The document discusses the evaluation and differential diagnosis of splenomegaly. It outlines the definition, symptoms, causes, workup and management of an enlarged spleen.

    The document recommends taking a thorough history, performing a physical exam, ordering relevant lab tests, and using imaging studies to systematically evaluate for the underlying cause of splenomegaly.

    Common causes of splenomegaly discussed include infections, portal hypertension, hematologic disorders, infiltrative processes, and tropical splenomegaly.

    SPLENOMEGALY- INTEGRATED

    APPROACH TO DIAGNOSIS
    GUIDE : DR. ATUL SHENDE CANDIDATE: DR. SARATH MENON.R DIVISION OF GASTROENTEROLOGY MGM MEDICAL COLLEGE,INDORE

    INTRODUCTION

    Definition & symptoms Classification Hypersplenism Etiology Step-wise approach

    Associated features
    Investigations

    black

    Galen source of black bile or melancholia

    NORMAL SPLEEN

    Normal size 12 cm length , 7 cm width (radionuclide scan) -13cm craniocaudal diamtr (USG) weight- < 250gm Located along- 9th, 10th,11th ribs mid-axillary Spleen should be twice the size to be PALPABLE

    Palpable spleens are not always ABNORMAL 3% normal population has palpable spleen

    FUNCTIONS

    Quality control over RBC culling & pitting Synthesis of antibodies

    Removal of antibody coated bacteria & RBC

    EXAMINATION OF SPLEEN
    Inspection Percussion nixon method - rt.lateral ducubitus, > 8cm - castells method supine,lower ICS ,full exp & insp splenomegaly=dullness - traubes sign supine,6th rib,costal margin, anterior axill. line splenomegaly= dullness Palpation - bimanual method,hooking maneuver

    TRAUBES SPACE

    BIMANUAL PALPATION

    DIFFERENCES
    spleen kidney

    Sharp edge Notch med border Cross midline Moves with respiration Cannot get above it

    Round edge No notch Not cross midline Not moves with resp.

    Can get above it

    SPLENOMEGALY

    Mild,moderate,massive

    Massive - beyond umblicus, crosses mid line into pelvis (>8cm) Moderate- b/w costal margin & umblicus (4-8cm)

    Mild -

    just palpable (1-3cm)

    HYPERSLENISM

    Splenomegaly Pancytopenia

    Presence of hypercellular marrow


    Reversal with splenectomy

    SYMPTOMS OF SPLENOMEGALY

    Pain Early satiety

    Feeling of heaviness in LUQ

    MECHANISM OF SPENOMEGALY
    Reactive Reticulo-endothelial hyperplasia Lymphoid hyperplasia Proliferation of lymphoma cells Infiltration by abnormal cells Extramedullary hemopoeisis Proliferation of macrophages d/t RBC destruction Vascular congestion

    CAUSES OF SPLENOMEGALY

    Infective Hyperplastic

    Congestive
    Infiltration

    INFECTIVE Acute & subacute- IMN, infective endocarditis, severe pyogenic inf. Viral hepatitis,CMV,AIDS Chronic - TB,syphilis,brucellosis Tropical splenomegaly Malaria,kala azar, trypanosomiasis

    CONGESTIVE Intra hepatic obst.portal hypertension - cirrhosis,biliary cirrhosis,hemochromatosis - primary sclerosing cholangitis Extra-hepatic portal hypertension - venous malf,thrombosis,stenosis - ext.occlusion of portal,splenic vein Chronic passive congestion of cardiac origin

    HYPERPLASTIC

    Extramedullary hemopoeisis- myeloprolif.d/s - marrow damage - marrow infiltration

    Reticulo endothelial hyperplasia (abn.RBC) - sickle cell d/s,spherocytosis,Hbnopathies, thalassemia major,PNH

    INFILTRATIVE Malignant infiltration- CML,lymphoblastic - lymhomas, MPD, - angiosarcoma,tumors - metastasis (melanoma) benign - storage d/s Gauchers,Neiman-pick - amyloidosis - hurlers syndrome,MPS - cysts,fibromas,hemangiomas,hamartomas -Eosnophilic granulomas

    DISORDERED IMMUNOREGULATION

    Feltys syndrome- RA+ splenomegaly+leucopenia Systemic lupus erythromatosis

    Collagen vascular diseases


    Sarcoidosis Immune thrombocytopenia

    MASSIVE SPLENOMEGALY (>8CM >1000GM)


    Myeloproliferative disorder Chronic malaria,kala-azar (trop. Splenomegaly) Storage disorders Thalassemia major Sarcoidosis Hairy cell leukemia Gaucher disease Diffuse splenic hemangiomatosis

    MODERATE SPLENOMEGALY(4-8CM)
    Cirrhosis Lymphomas Amyloid Splenic abscess,infarct Hemolytic anemias IMN

    MILD SPLENOMEGALY (1-3CM)


    Acute infective conditons Acute malaria,tyhoid,kala-azar,septicemias

    STEP-WISE APPROACH TO SPLENOMEGALY


    History Physical examination Laboratory testings Imaging Specialised testing

    HISTORY

    Age ,gender Race h/o recent infections like malaria Fever,weight loss,sweating (lymphomas,infections) Pruritis Abnormal bleeding/bruising Joint pain h/o alcholism h/o trauma h/o neonatal umblical sepsis Residence & travel abroad

    HISTORY

    ..CONT

    Jaundice High risk sexual behavior (AIDS) Past medical history Drugs

    PHYSICAL EXAMINATION
    Size of the spleen Hepatomegaly Lymphadenopathy Fever Icterus Bruising,petechiae Oral & supf.sepsis Stigmata of liver disease Stigmata of RA/SLE Splinter hemorrhage,retinal hemorrhage Cardiac murmurs

    LAB INVESTIGATIONS
    CBC Blood smear Retic count Blood C/S Serology (fungal,viral,parasitic) LFT Hb electropheresis/ coombs test Coag.profile Amylase/lipase AMA, Anti CCP,RA factor Bone marrow analysis

    IMAGING
    USG- sensitive & specific non-invasive CT scan etiology of splenomegaly - liver size,heterogenecity - splenic mets, abscess,calcf.,cysts - retro peritoneal LN - craniocaudal ln > 10 cm Liver- spleen colloid scan- (RBC Cr51,Tc99) - hepatic steatosis,SOL,splenic functions - PHT,colloid shift + MRI/ Doppler usg- portal/splenic vein thrombosis - cavernomas

    IMAGING MRI scan- liver hemangiomas hemochromatosis erlenmeyer flask sign(Gaucher) PET scan - Dx & staging of lymphomas - determine metabolic cells in spleen

    SPECIALISED TESTING
    Abd.fat pad aspiration JAK-2 mutation Gene testing(bcr-abl ,C282Y) Enzyme testing Lymph node biopsy FNAB spleen Splenectomy Lung or skin biopsy Liver biopsy

    SPECIAL SITUATIONS ASSOCIATED WITH


    SPLENOMEGALY Fever- typhoid,malaria,kalaazar, infect.endocarditis, leukemia,lymphoma Tender spleen- rupture,abscess,infarct a/c illness+ anemia- AIHA,leukemia Fever + LN- IMN,leukemia,lymhomas,SLE,sarcoid Anemia- hemolytic anemia,hemoglobinopathies Jaundice cirrhosis,hemolytic anemia Pulsatile spleen- aneurysm High ESR- connective tissue disorder Leukopenia- feltys syndrome,septicemia

    TROPICAL SPLENOMEGALY (HMS)


    Massive splenomegaly Endemic areas of malaria,kala-azar IgM antibodies + No parasite in blood Lymhocytic infiltration of splenic sinusoids Long term anti-malarials

    SUMMARY

    Splenomegaly major physical finding Step wise approach- history,physical exam

    Look for associated features


    Lab investigation & Imaging Search for etiology & treat

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