SPLENOMEGALLY

Definition

Splenomegaly is an enlargement of the spleen beyond its normal size.

Alternative Names

Spleen enlargement; Enlarged spleen

Considerations

The spleen is an organ that is a part of the lymph system. It filters the blood and maintains healthy red and white blood cells and platelets.
Because of its wide variety of functions, the spleen may be affected by many conditions involving the blood or lymph system, and by infection, malignancies, liver disease, and parasites.
Symptoms of splenomegaly include:

• Inability to eat a large meal
• Pain on the upper left side of the abdomen
• Hiccups

Splenomegaly is an enlargement of the spleen. The spleen 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 tosplenectomy. Splenomegaly is usually associated with increased workload (such as inhemolytic 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 toportal 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

Contents  [hide] 1 Definition 2 Symptoms and signs 3 Causes 4 Treatment 5 See also 6 References 7 External links

[edit]Definition

Splenomegaly is defined as spleen size > 12 cm.^{[citation needed]} Poulain et al. classify splenomegaly 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, chest pain, chest pain similar to pleuritic pain when stomach, bladder or bowels are full, 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 examinationby 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, bacterialsepticemia 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 hepaticschistosomiasis hepatic echinococcosis	Metabolic diseases Gauchers disease Niemann-Pick disease Alpha-mannosidosis Hurler syndrome and otherMucopolysaccharidoses 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:

• thalassemia
• visceral leishmaniasis (Kala Azar)
• schistosomiasis
• chronic myelogenous leukemia
• chronic lymphocytic leukemia
• lymphomas
• hairy cell leukemia
• myelofibrosis
• polycythemia vera
• Gauchers disease
• Niemann Pick disease
• sarcoidosis
• autoimmune hemolytic anemia
• malaria

[edit]Treatment

If the splenomegaly underlies hypersplenism, a splenectomy is indicated and will correct the hypersplenism. However, the underlying cause of the hypersplenism will most likely remain, so a thorough diagnostic workup is still indicated, as leukemia, lymphoma, and other serious disorders can cause hypersplenism and splenomegaly. 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.