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Splenomegaly

 

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Splenomegaly



 
 
Splenomegaly is an enlargement of the spleen
Spleen

The spleen is an organ found in all vertebrate animals. In humans, the spleen is located in the abdomen of the body, where it functions in the destruction of redundant red blood cells, and holds a reservoir of blood....
, which usually lies in the left upper quadrant (LUQ) of the human abdomen
Human abdomen

The human abdomen is the part of the body between the pelvis and the chest. Anatomically, the abdomen stretches from the thorax at the thoracic diaphragm to the pelvis at the pelvic brim....
. It is one of the four cardinal signs of hypersplenism, the other three being cytopenia
Cytopenia

Cytopenia is a reduction in the number of blood cells. It takes a number of forms:*Low red blood cell count: anemia.*Low white blood cell count: leukopenia or neutropenia ....
(s), normal or hyperplastic bone marrow, and a response to splenectomy
Splenectomy

A splenectomy is a procedure that involves the removal of the spleen by Surgery means....
. Splenomegaly is usually associated with increased workload (such as in hemolytic anemia
Hemolytic anemia

Hemolytic anemia is anemia due to hemolysis, the abnormal breakdown of red blood cells either in the blood vessels or elsewhere in the body . It has numerous possible causes, ranging from relatively harmless to life-threatening....
s), which suggests that it is a response to hyperfunction. It is therefore not surprising that splenomegaly is associated with any disease
Disease

A disease or medical condition is an abnormal condition of an organism that impairs bodily functions, associated with specific symptoms and Medical signs....
 process that involves abnormal red blood cell
Red blood cell

Red blood cells are the most common type of blood cell and the vertebrate body's principal means of delivering oxygen to the body tissues via the blood....
s being destroyed in the spleen.






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Encyclopedia


Splenomegaly is an enlargement of the spleen
Spleen

The spleen is an organ found in all vertebrate animals. In humans, the spleen is located in the abdomen of the body, where it functions in the destruction of redundant red blood cells, and holds a reservoir of blood....
, which usually lies in the left upper quadrant (LUQ) of the human abdomen
Human abdomen

The human abdomen is the part of the body between the pelvis and the chest. Anatomically, the abdomen stretches from the thorax at the thoracic diaphragm to the pelvis at the pelvic brim....
. It is one of the four cardinal signs of hypersplenism, the other three being cytopenia
Cytopenia

Cytopenia is a reduction in the number of blood cells. It takes a number of forms:*Low red blood cell count: anemia.*Low white blood cell count: leukopenia or neutropenia ....
(s), normal or hyperplastic bone marrow, and a response to splenectomy
Splenectomy

A splenectomy is a procedure that involves the removal of the spleen by Surgery means....
. Splenomegaly is usually associated with increased workload (such as in hemolytic anemia
Hemolytic anemia

Hemolytic anemia is anemia due to hemolysis, the abnormal breakdown of red blood cells either in the blood vessels or elsewhere in the body . It has numerous possible causes, ranging from relatively harmless to life-threatening....
s), which suggests that it is a response to hyperfunction. It is therefore not surprising that splenomegaly is associated with any disease
Disease

A disease or medical condition is an abnormal condition of an organism that impairs bodily functions, associated with specific symptoms and Medical signs....
 process that involves abnormal red blood cell
Red blood cell

Red blood cells are the most common type of blood cell and the vertebrate body's principal means of delivering oxygen to the body tissues via the blood....
s being destroyed in the spleen. Other common causes include congestion due to portal hypertension
Portal hypertension

In medicine, portal hypertension is hypertension in the portal vein and its tributaries.It is often defined as a portal pressure gradient of 5 mm Hg or greater....
 and infiltration by leukemias and lymphomas. Thus, the finding of an enlarged spleen; along with caput medusa; is an important sign of portal hypertension.

Gray1217

Definition

Splenomegaly is defined as spleen size > 12cm.

Symptoms and signs


Symptoms may include abdominal pain
Abdominal pain

Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom....
, early satiety due to splenic encroachment, or the symptoms of anemia
Anemia

Anemia or an?mia/anaemia is defined as a qualitative or quantitative deficiency of hemoglobin, a protein found inside red blood cells ....
 due to accompanying cytopenia.

Sign
Medical sign

A medical sign is an Objectivity indication of some medical fact or characteristic that may be detected by a physician during a physical examination of a patient....
s of splenomegaly may include a palpable left upper quadrant abdominal mass
Abdominal mass

An abdominal mass is any localized enlargement or swelling in the human abdomen. Depending on its location, the abdominal mass may be caused by an enlarged liver , enlarged spleen , protruding kidney, a pancreatic mass, a retroperitoneal mass , an abdominal aortic aneurysm, or various tumours, such as those caused by abdominal carcinomatosis...
 or splenic rub. It can be detected on physical examination
Physical examination

File:Reeve 978.jpgPhysical examination or clinical examination is the process by which a health care provider investigates the body of a patient for sign of disease....
 by using Castell's sign
Castell's sign

Castell's sign is a sign assessed to evaluate splenomegaly and typically part of an abdominal examination. It is an alternative physical examination maneuver to Traube's sign....
 or Traube's space
Traube's space

Traube's space is an anatomic region of some clinical importance. It's a crescent-shaped space, encompassed by the lower edge of the left lung, the anterior border of the spleen, the left costal margin and the inferior margin of the left lobe of the liver....
, but an ultrasound
Ultrasound

Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing . Although this limit varies from person to person, it is approximately 20 Hertz in healthy, young adults and thus, 20 kHz serves as a useful lower limit in describing ultrasound....
 can be used to confirm diagnosis.

Causes

Splenomegaly grouped on the basis of the pathogenic mechanism
Increased function Abnormal blood flow Infiltration
Removal of defective RBCs spherocytosis
Spherocytosis

Spherocytosis is an auto-hemolysis anemia characterized by the production of red blood cells , or erythrocytes, that are sphere-shaped, rather than bi-concave disk shaped....

thalassemia
Thalassemia

Thalassemia is an inherited autosomal recessive blood disease. In thalassemia, the genetic defect results in reduced rate of synthesis of one of the globin chains that make up hemoglobin....

hemoglobinopathies
nutritional anemias
early sickle cell anemia
Immune hyperplasia
Response to infection (viral,bacterial,fungal,parasitic)
mononucleosis
Mononucleosis

Mononucleosis is a condition where there is an unusual proliferation of monocytes. Its meaning is similar to the condition of monocytosis.Sometimes, the use of the term implies Epstein-Barr virus , but it is also possible for cytomegalovirus to cause mononucleosis....
, AIDS
AIDS

Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the HIV ....
, viral hepatitis
Viral hepatitis

Viral hepatitis is Hepatitis due to a viral infection. It may present in acute or chronic forms. The most common causes of viral hepatitis are the five unrelated hepatotropic viruses Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, and Hepatitis E....

subacute bacterial endocarditis, bacterial septicemia
splenic abscess
Abscess

An abscess is a collection of pus that has accumulated in a cavity formed by the tissue on the basis of an infection process or other foreign materials ....
, typhoid fever
Typhoid fever

Typhoid fever, also known as enteric fever, or commonly just typhoid, is an illness caused by the bacterium Salmonella typhi. Common worldwide, it is transmitted by the ingestion of food or water contaminated with feces from an infected person....

brucellosis
Brucellosis

Brucellosis, also called undulant fever, or Malta fever, is a highly contagious zoonosis caused by ingestion of Sterilization_ milk or meat from infected animals, or close contact with their secretions....
, leptospirosis, tuberculosis
Tuberculosis

Tuberculosis is a common and often deadly infectious disease caused by mycobacterium, mainly Mycobacterium tuberculosis . Tuberculosis usually attacks the lungs but can also affect the central nervous system, the lymphatic system, the circulatory system, the genitourinary system, the gastrointestinal system, bones, joints, and even the...

histoplasmosis
Histoplasmosis

Histoplasmosis, also known as Darling's disease,is a disease caused by the fungus Histoplasma capsulatum. Symptoms of this infection vary greatly, but the disease primarily affects the lungs....

malaria
Malaria

Malaria is a Vector -borne infectious disease caused by protozoan parasites. It is widespread in Tropics and subtropical regions, including parts of the Americas, Asia, and Africa....
, leishmaniasis
Leishmaniasis

Leishmaniasis is a disease caused by protozoan parasites that belong to the genus Leishmania and is transmitted by the bite of certain species of sand fly ....
, trypanosomiasis
Trypanosomiasis

Trypanosomiasis or trypanosomosis is the name of several diseases in vertebrates caused by parasite protozoan trypanosomes of the genus Trypanosoma....

ehrlichiosis
Ehrlichiosis

Ehrlichiosis is a tick-borne disease of dogs usually caused by the organism Ehrlichia canis. Ehrlichia canis is the pathogen of animals....

Disordered immunoregulation
rheumatoid arthritis
Rheumatoid arthritis

Rheumatoid arthritis is a chronic, systemic disease inflammation that may affect many tissues and organs, but principally attacks the joints producing a inflammatory synovitis that often progresses to destruction of the articular cartilage and ankylosis of the joints....

SLE
SLE

SLE can mean:* Supporting Leading Edge, a term used to describe a structure of a power kite* Systemic lupus erythematosus, an autoimmune disease affecting multiple systems in the body...

Serum sickness
Serum sickness

Serum sickness is a reaction to proteins in antiserum derived from an animal source. It is a type of hypersensitivity, specifically immune complex hypersensitivity ....

Autoimmune hemolytic anemia
Autoimmune hemolytic anemia

Autoimmune hemolytic anemia is a type of hemolytic anemia where the body's immune system attacks its own red blood cells , leading to their destruction ....

Immune thrombocytopenia
Idiopathic thrombocytopenic purpura

Idiopathic thrombocytopenic purpura is the condition of having a low platelet platelet count of no known cause . As most causes appear to be related to antibody against platelets, it is also known as immune thrombocytopenic purpura or immune-mediated thrombocytopenic purpura....

sarcoidosis
Sarcoidosis

Sarcoidosis, also called sarcoid or Besnier-Boeck disease, is a multisystem disorder characterized by non-caseating granulomas . It most commonly arises in young adults....

drug reactions
Extramedullary hematopoiesis
Myelofibrosis
Myelofibrosis

Myelofibrosis, also known as myeloid metaplasia, chronic idiopathic myelofibrosis, and primary myelofibrosis, is a disorder of the bone marrow, in which the marrow undergoes fibrosis - replacement by fibrous tissue ....

Marrow infiltration by tumors, leukemias
marrow damage by radiation
Radiation

In physics, radiation describes any process in which energy emitted by one body travels through a medium or through space, ultimately to be absorbed by another body....
, toxins
Organ Failure
cirrhosis
Cirrhosis

Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver Tissue by fibrous scar tissue as well as regenerative Nodule , leading to progressive loss of liver function....

congestive heart failure
Congestive heart failure

Heart failure is a condition in which a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body's needs....

Vascular
hepatic vein obstruction
portal vein obstruction
Portal vein thrombosis

Portal vein thrombosis is a form of venous thrombosis affecting the hepatic portal vein, which can lead to portal hypertension and reduction in the blood supply to the liver....

Budd-Chiari syndrome
Budd-Chiari syndrome

In medicine , Budd-Chiari syndrome is the clinical picture caused by occlusion of the hepatic veins. It presents with the classical triad of abdominal pain, ascites and hepatomegaly....

splenic vein obstruction
Infections

hepatic schistosomiasis
Schistosomiasis

Schistosomiasis is a parasitic disease caused by several species of Trematoda of the genus Schistosoma.Although it has a low mortality rate, schistosomiasis often is a chronic illness that can damage internal organs and, in children, impair growth and cognitive development....

hepatic echinococcosis
Echinococcosis

Echinococcosis, also known as hydatid disease, hydatid cyst, unilocular hydatid disease or cystic echinococcosis, is a potentially fatal parasitic disease that can affect many animals, including wildlife, commercial livestock and humans....
|Metabolic diseases
Gauchers disease
Niemann-Pick disease
Niemann-Pick disease

Niemann-Pick disease refers to a group of fatal inherited metabolic disorders that are included in the larger family of lysosomal storage diseases ....

Alpha-mannosidosis
Alpha-mannosidosis

Alpha-mannosidosis is an autosomal recessive lysosomal storage disorder caused by deficient activity of the enzyme alpha-D-mannosidase....

Hurler syndrome
Hurler syndrome

Hurler syndrome, also known as mucopolysaccharidosis type I , Hurler's disease or gargoylism, is a genetic disorder that results in the buildup of mucopolysaccharides due to a deficiency of alpha-L iduronidase, an enzyme responsible for the degradation of mucopolysaccharides in lysosomes....
 and other Mucopolysaccharidoses
Amyloidosis
Amyloidosis

In medicine, amyloidosis refers to a variety of conditions in which amyloid proteins are abnormally deposited in organ s and/or Tissue s. A protein is described as being amyloid if, due to an alteration in its secondary structure, it takes on a particular aggregated insoluble form similar to the beta-pleated sheet....

Tangier disease
Tangier disease

Tangier disease is a rare inherited disorder characterized by a severe reduction in the amount of high density lipoprotein , often referred to as "good cholesterol," in the bloodstream....

Benign and malignant infiltrations
Leukemias(acute,chronic,lymphoid and myeloid)
lymphomas(Hodgkins
Hodgkins

Hodgkins may refer to:*Hodgkin's lymphoma, a type of cancer*Frances Hodgkins, an abstract painter*W. M. Hodgkins, New Zealand painter, father of Frances Hodgkins...
 and non-hodgkins
Non-Hodgkin lymphoma

The non-Hodgkin lymphomas are a diverse group of hematological malignancy which encompass any lymphoma other than Hodgkin lymphoma.Lymphoma is a type of cancer derived from lymphocytes, a type of white blood cell....
)
myeloproliferative disorders
metastatic tumors(commonly melanoma
Melanoma

Melanoma is a malignant tumor of melanocytes which are found predominantly in skin but also in the bowel and the eye . It is one of the rarer types of skin cancer but causes the majority of skin cancer related deaths....
)
histiocytosis X
Hemangioma
Hemangioma

A hemangioma is a congenital benign tumour or vascular malformation of endothelial cells .In infancy, it is the most common tumor....
,lymphangioma
Lymphangioma

Lymphangioma is a lymphatic malformation, a benign proliferation of lymph vessels, forming a yellowish tumor on the skin, composed of a mass of dilated lymph vessels....

splenic cysts
hamartomas
eosinophilic granuloma


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

    Thalassemia is an inherited autosomal recessive blood disease. In thalassemia, the genetic defect results in reduced rate of synthesis of one of the globin chains that make up hemoglobin....
  • visceral leishmaniasis
    Visceral leishmaniasis

    Visceral leishmaniasis , also known as kala-azar and black fever, is the most severe form of leishmaniasis. Leishmaniasis is a disease caused by protozoan parasites of the Leishmania genus....
     (Kala Azar)
  • schistosomiasis
    Schistosomiasis

    Schistosomiasis is a parasitic disease caused by several species of Trematoda of the genus Schistosoma.Although it has a low mortality rate, schistosomiasis often is a chronic illness that can damage internal organs and, in children, impair growth and cognitive development....
  • chronic myelogenous leukemia
    Chronic myelogenous leukemia

    Chronic myelogenous leukemia , also known as chronic granulocytic leukemia , is a form of leukemia characterized by the increased and unregulated growth of predominantly myeloid cells in the bone marrow and the accumulation of these cells in the blood....
  • chronic lymphocytic leukemia
    Chronic lymphocytic leukemia

    B-cell chronic lymphocytic leukemia , is a type of leukemia, or cancer of the white blood cells . CLL affects a particular lymphocyte, the B cell, which originates in the bone marrow, develops in the lymph nodes, and normally fights infection....
  • lymphomas
  • hairy cell leukemia
    Hairy cell leukemia

    Hairy cell leukemia is a mature B cell neoplasm. It is usually classified as a sub-type of chronic lymphoid leukemia for convenience. It is uncommon, representing about 2% of all leukemias, or less than a total of 2000 new cases diagnosed each year in North America and Western Europe combined....
  • myelofibrosis
    Myelofibrosis

    Myelofibrosis, also known as myeloid metaplasia, chronic idiopathic myelofibrosis, and primary myelofibrosis, is a disorder of the bone marrow, in which the marrow undergoes fibrosis - replacement by fibrous tissue ....
  • polycythemia vera
    Polycythemia vera

    Primary polycythemia, often called polycythemia vera , polycythemia rubra vera , or erythremia, occurs when excess red blood cells are produced as a result of an abnormality of the bone marrow and occasionally in the kidneys....
  • Gauchers disease
  • Niemann Pick disease
  • sarcoidosis
    Sarcoidosis

    Sarcoidosis, also called sarcoid or Besnier-Boeck disease, is a multisystem disorder characterized by non-caseating granulomas . It most commonly arises in young adults....
  • autoimmune hemolytic anemia
    Autoimmune hemolytic anemia

    Autoimmune hemolytic anemia is a type of hemolytic anemia where the body's immune system attacks its own red blood cells , leading to their destruction ....
  • malaria
    Malaria

    Malaria is a Vector -borne infectious disease caused by protozoan parasites. It is widespread in Tropics and subtropical regions, including parts of the Americas, Asia, and Africa....


Treatment

If the splenomegaly underlies hypersplenism, a splenectomy
Splenectomy

A splenectomy is a procedure that involves the removal of the spleen by Surgery means....
 is indicated and will correct the problem. After splenectomy, however, patients have an increased risk for infectious diseases.

After splenectomy, patients should be vaccinated
Vaccine

A vaccine is a biological preparation that establishes or improves immunity to a particular disease.Vaccines can be prophylaxis , or Medication ....
 against Haemophilus influenzae
Haemophilus influenzae

Haemophilus influenzae, formerly called Pfeiffer's bacillus or Bacillus influenzae, is a non-motile Gram-negative coccobacillus first described in 1892 by Richard Friedrich Johannes Pfeiffer during an influenza pandemic....
 and Streptococcus pneumoniae
Streptococcus pneumoniae

Streptococcus pneumoniae, or pneumococcus, is a Gram-positive, Hemolysis diplococcus aerotolerant anaerobe and a member of the genus Streptococcus....
. They should receive annual influenza vaccinations. Long-term prophylactic
Prophylaxis

Prophylaxis is any medical or public health procedure whose purpose is to prevent, rather than treat or cure a disease. Roughly, prophylactic measures are divided between primary prophylaxis and secondary prophylaxis ....
 antibiotic
Antibiotic

In common usage, an antibiotic is a substance or compound that kills or inhibits the growth of bacteria. Antibiotics belong to the group of antimicrobial compounds used to treat infections caused by microorganisms, including fungus and protozoa....
s should be given.

See also

  • sign (medicine)
  • Hepatosplenomegaly
    Hepatosplenomegaly

    Hepatosplenomegaly is the simultaneous enlargement of both the liver and the spleen . Hepatosplenomegaly can occur as the result of acute viral hepatitis, infectious mononucleosis or can be the sign of a serious and life threatening lysosomal storage disease....
  • Splenic infarction
    Splenic infarction

    In medicine, splenic infarction is a condition in which oxygen supply to the spleen is interrupted, leading to partial or complete infarction in the organ....


External links

(Hypersplenism)