Splenomegaly is almost always secondary to other disorders. Jan 22, 2019 splenomegaly is a pathological condition in which spleen of an individual gets enlarged. Splenomegaly occurs in 1045% of patients, particularly during active disease. The opening chapters deal with the preliminary general appraisal of the patient for a. However, little is known about the prevalence and clinical significance of this finding in asymptomatic patients. One third of neonates and one tenth of children may have a normal, palpable spleen. In the past, splenomegaly was a clinical finding, but in recent years, imaging studies have also helped to assess for or confirm mild splenomegaly.
Tropical splenomegaly massive splenomegaly occurring in people of endemic area for malariakalaazar but no parasite is demonstrable in blood. In patients where the likelihood of splenomegaly is high, the physical exam is not sufficiently sensitive to detect it. Splenomegaly in children see approach to the child with an enlarged spleen. Article pdf available in british medical journal 26043. Get a printable copy pdf file of the complete article 932k, or click on a page image below to browse page by page. Palpation and percussion of the spleen are important techniques for identifying an enlarged. The spleen grows downwards and towards the right iliac fossa. It enlarges towards the right iliac fossa rif always start palpation in the rif and move across towards the right upper quadrant or a massive splenomegaly may be missed. Splenomegaly is abnormal enlargement of the spleen.
Although several methods of palpation and percussion of the spleen have been described, until recently they have not been validated by noninvasive imaging techniques such as ultrasonography, radionuclide scanning, and computed tomography that offer objective means to assess splenomegaly. Pointofcare ultrasonography improves the diagnosis of splenomegaly in hospitalized patients. Splenomegaly and hypersplenism information page patient. What is splenomegalycausessymptomstreatmentdiagnosis. Physical examination of the spleen is performed with the patient in. Splenomegaly is a sign of an underlying condition, such as severe liver disease, leukemia, or mononucleosis. Introduction as early as the 17th century, it was realized that structural changes in the portal circulation could cause gastrointestinal bleeding. Pdf reliability of clinical techniques for detecting splenic. Up to 3% of normal, thin, people have a palpable spleen. Splenomegaly increases the spleens mechanical filtering and destruction of red blood cells rbcs and often of white blood cells wbcs and platelets. Your doctor can often feel it by gently examining your left upper abdomen. To determine whether sonographic versions of physical examination techniques can accurately identify splenomegaly. Also, a palpable left upper quadrant mass may indicate a problem other than an enlarged spleen such as a hypernephroma. If confirmation of splenomegaly is necessary because the examination is equivocal, ultrasonography is the test of choice because of its accuracy and low cost.
However, it may also refer to an enlarged spleen detected by an imaging test. A person with splenomegaly should take care to avoid all contact sports and any other activities that could potentially deliver a hard impact to their abdomen. Cause of splenomegaly is obscurelymphocytic infiltration of splenic liver sinosoids present. Splenic tuberculosis presenting as pyrexia of unknown origin. Splenomegaly american academy of pediatrics textbook of. Splenomegaly causes of splenomegaly portal hypertension 33% chronic liver disease portalsplenic venous obstruction. Know the causes, symptoms, and treatment of splenomegaly. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. This book is composed of eight chapters that also outline the physical signs encountered in common medical conditions. Files are available under licenses specified on their description page. Mild to moderate splenomegaly may be recorded in the bilag index but not in other indices, such as sledai and eclam.
Your doctor may confirm the diagnosis of an enlarged spleen with one or. However, when the tip of the spleen is felt beyond 2 cm below the left costal margin, it is considered abnormal. Splenomegaly is a feature of a broad range of diseases, and presents to clinicians in many fields. The sensitivity for detection of ultrasounddocumented splenic enlargement is 60 to 70% for palpation and 60 to 80% for percussion. Physical examination size of the spleen hepatomegaly. Source diseases database splenomegaly is listed as a rare disease by the office of rare diseases ord of the national institutes of health nih. Splenomegaly is defined as enlargement of the spleen, measured by size or weight. All structured data from the file and property namespaces is available under the creative commons cc0 license. This means that splenomegaly, or a subtype of splenomegaly, affects less than 200,000 people in the us population.
Splenomegaly is most often discovered under physical examination. The content on the uptodate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. If your institution subscribes to this resource, and you dont have a myaccess profile, please contact your librarys reference desk for information on how to. The spleen is a functionally diverse organ with active roles in immunosurveillance and hematopoiesis. In 1902, gilbert and carnot introduced the term portal hypertension to describe this condition. Splenomegaly symptoms, diagnosis, treatments and causes. We have a wonderfully rich tradition of physical diagnosis, and my hope is that this book will help square. Causes of splenomegaly are myriad, as are the many possible ways of classifying them see table common causes of splenomegaly. The pocket guide to physical examination and history taking. Splenomegaly hematology and oncology merck manuals. Kelley, textbook of internal medicine, 3rd edition, 1997.
An enlarged spleen is usually detected during a physical exam. Ct and mri may provide more detail of the organs consistency. Splenomegaly is an enlargement of the spleen resulting from abnormalities of its lymphoid, reticuloendothelial, or vascular components. Splenomegaly is defined as enlargement of the spleen measured by weight or size. Spleen exam stanford medicine 25 stanford medicine. Although splenomegaly is often considered to be an ominous clinical finding, certain normal variants have been found. Does this patient have intestinal obstruction blockage of intestine. Jan 09, 2018 splenomegaly is defined as enlargement of the spleen, measured by size or weight. A perfunctory examination while assuming the spleen is not going to be palpable is the best way to miss an enlarged spleen. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. An overzealous palpation of the abdomen or a sudden blow can split the outer capsule of the spleen and cause bleeding into the abdominal cavity.
Hypersplenism is a secondary process that can arise from splenomegaly of almost any cause see table common causes of splenomegaly. The detection of an enlarged spleen is important in clinical diagnosis but seems to. Splenomegaly general presentation the spleen is a hematopoietic organ supporting the megakaryotic, lymphoid, erythroid, myeloid, and reticuloendothelial systems. Mri is especially useful in detecting portal or splenic vein thromboses. In some patients, extensive radiological and laboratory investigations will fail to yield a diagnosis. This book is distributed under the terms of the creative commons. Olson ap, trappey b, wagner m, newman m, nixon lj, schnobrich d. If your institution subscribes to this resource, and you dont have a myaccess profile, please contact your librarys reference desk for information on how to gain access to this resource from offcampus. Pdf comparing physical examination with sonographic versions.
In cases in which splenomegaly is questioned, the clinical examination is more specific than sensitive and is best used when ruling in the diagnosis among patients for whom the suspicion is at least 10%. The evaluation of splenomegaly in children and considerations related to elective or traumatic splenectomy are discussed separately. One case was confirmed during explorative laparotomy, performed due to ileus. However, in some people especially those who are slender a healthy, normalsized spleen can sometimes be felt during an exam. Physical diagnosis of the abdomen university of virginia. The splenomegaly diagnosis was confirmed for the first time by us in 60% of the patients, ct in 27%, palpation in 10%, other method of examination 2%, and excision in 1%. Describe how the physical examination affects the physicianpatient. Population for whom the physical examination of splenomegaly should be sought. A 48 yearold woman with abdominal cramping, vomiting, and no bowel movement for 2 days.
Jan 09, 2018 a multicentre observational study for early diagnosis of gaucher disease in patients with splenomegaly andor thrombocytopenia. Physical diagnosis in medicine covers the procedures for physical examination and for diagnosis of common causes of abnormal physical signs. Bates pocket guide to physical examination and history taking. Full text full text is available as a scanned copy of the original print version. Other functions include filtering senescent and defective red blood cells, presenting antigens to the immune system, and destroying. It has been found in up to 70% in a postmortem study. The use of manual therapy or therapeutic touch has generated extensive literature. Evaluation of splenomegaly differential diagnosis of. It can be detected on physical examination by using castells sign, traubes space percussion or nixons sign, but an ultrasound can be used to confirm diagnosis.
Patients with splenomegaly should avoid activities that risk trauma to the abdomen, including contact sports, because of risk of bleeding from the injured spleen. Describe how the physical examination affects the physicianpatient relationship. A systematic guide to physical diagnosis 7th edition pdf author nicholas j talley md nsw phd syd mmedsci clin epinewc. It is a reservoir for platelets and a site for the proliferation of blymphocytes. In part this is because the spleen enlarges in the inferior anteromedial direction, sometimes as far as the rlq. This condition affects less than 1% of patients with rheumatoid arthritis. Tuberculosis of the spleen as a cause of fever of unknown origin and splenmegaly. Splenomegaly can be found in 3% of the normal population.
Tuberculous splenomegaly with the hypersplenism syndrome. Moreover, the examination should start with traube space percussion, followed, if dull, by supine 1handed palpation. Splenomegaly can be caused due to various medical conditions like some sort of an infection or problems with the liver. The term splenomegaly generally denotes a palpably enlarged spleen. Enlarged spleen splenomegaly diagnosis and treatment. This condition as a whole is difficult to diagnose due to its. Morphologic approach microcytic anemia mcv splenomegaly is a frequent finding among hivinfected adults 1, 2. This topic provides an overview of normal splenic size and function and an approach to evaluating splenic abnormalities in adults. Sep 09, 2016 during two evaluations of refugee populations in western uganda in march and july 2015, refugees with splenomegaly on physical examination were offered additional assessment and treatment, including abdominal ultrasonography and laboratory testing.
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