Splenomegaly

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Splenomegaly

Causes

Massive splenomegaly

• Myeloproliferative disease
  • Myelofibrosis
  • Chronic Myeloid Leukaemia
• Malaria
• Kala-azar

Moderate Splenomegaly (as above plus...)

• Haemolytic Anaemia

• Lymphoproliferative disease

  • Chronic Lymphocytic Leukaemia

  • Lymphoma

  • Myelomatosis (???)

  • Acute Lymphocytic Leukaemias

• Portal Hypertension

  • Cirrhosis

  • Hepatic vein obstruction

Mild (plus...)

• Infection

  • Infectious Mononucleosis

  • Infective Endocarditis

• Infiltrates

  • Sarcoidosis

  • Amyloid

• Pernicious Anaemia

• Rheumatoid arthritis - (Felty's syndrome)

Or to put it another way...

• infectious

  • acute

    • septic shock

    • infective endocarditis

    • typhoid

    • infectious mononucleosis

  • chronic

    • tuberculosis

    • brucellosis

  • parasites

    • malaria

    • kala-azar

    • schistosomiasis

• inflammatory

  • rheumatoid arthritis

  • sarcoidosis

  • SLE

• Haematological

  • haemolytic anaemia

  • haemoglobinopathies

  • leukaemia

  • lymphoma

  • myeloproliferative disorders

• portal hypertension

• miscellaneous

  • storage disease

  • amyloid

  • neoplasm

  • tropical splenomegaly

Examination

• Inspection

  • swelling

  • bruising

  • purpura

• Palpation

  • RIF diagonally upwards

  • edge /  medial notch

  • moves with respiration

  • unable to palpate above

• Percuss

  • dull up to 9th rib / mid axillary line

• Auscultate

• Lymphadenopathy

  • cervical

  • axillary

  • inguinal

  • epitrochlear

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