This man presents with tiredness and lethargy. Please examine his abdominal system and discuss your
diagnosis.
Clinical signs To Look For:
General
• Anaemia
• Lymphadenopathy (axillae, cervical and inguinal areas)
• Purpura
Abdominal
• Left upper quadrant mass that moves inferomedially with respiration, has a notch, is dull to percussion and you cannot get above nor ballot
• Estimate size
• Check for hepatomegaly
Underlying cause
- Lymphadenopathy
- Haematological and Infective
- Stigmata of chronic liver disease
- Cirrhosis with portal hypertension
- Splinter haemorrhages, murmur, etc.
- Bacterial endocarditis
- Rheumatoid hands
- Felty’s syndrome
Discussion
Causes Of Splenomegaly
• Massive splenomegaly (>8 cm):
⚬⚬ Myeloproliferative disorders (CML and myelofibrosis)
⚬⚬ Tropical infections (malaria, visceral leishmaniasis: kala‐azar)
• Moderate (4–8 cm):
⚬⚬ Myelo/lymphoproliferative disorders
⚬⚬ Infiltration (Gaucher’s and amyloidosis)
• Tip (<4 cm):
⚬⚬ Myelo/lymphoproliferative disorders
⚬⚬ Portal hypertension
⚬⚬ Infections (EBV, infective endocarditis and infective hepatitis)
⚬⚬ Haemolytic anaemia
Investigations
• Ultrasound abdomen
Then if:
• Haematological cause:
⚬⚬ FBC and film
⚬⚬ CT chest and abdomen
⚬⚬ Bone marrow aspirate and trephine
⚬⚬ Lymph node biopsy
• Infectious cause:
⚬⚬ Thick and thin films (malaria)
⚬⚬ Viral serology
Indications for splenectomy
• Rupture (trauma)
• Haematological (ITP and hereditary spherocytosis)
Causes Of Splenomegaly
• Massive splenomegaly (>8 cm):
⚬⚬ Myeloproliferative disorders (CML and myelofibrosis)
⚬⚬ Tropical infections (malaria, visceral leishmaniasis: kala‐azar)
• Moderate (4–8 cm):
⚬⚬ Myelo/lymphoproliferative disorders
⚬⚬ Infiltration (Gaucher’s and amyloidosis)
• Tip (<4 cm):
⚬⚬ Myelo/lymphoproliferative disorders
⚬⚬ Portal hypertension
⚬⚬ Infections (EBV, infective endocarditis and infective hepatitis)
⚬⚬ Haemolytic anaemia
Investigations
• Ultrasound abdomen
Then if:
• Haematological cause:
⚬⚬ FBC and film
⚬⚬ CT chest and abdomen
⚬⚬ Bone marrow aspirate and trephine
⚬⚬ Lymph node biopsy
• Infectious cause:
⚬⚬ Thick and thin films (malaria)
⚬⚬ Viral serology
Indications for splenectomy
• Rupture (trauma)
• Haematological (ITP and hereditary spherocytosis)
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