Splenomegaly

Question 1

Signs of splenomegaly

Answer 1

LUQ mass
Moves inferomedially on resp
Has a notch, can't get above, can't ballot
Estimate size ?does it cross midline
? Hepatomeg

Question 2

Signs of cause of splenomegaly

Answer 2

Haem/infection: lymphadenopathy
Cirrhosis + portal htn: chronic liver disease signs
Bacterial endocarditis: splinter haemorrhage, murmur
Felty’s: RA, neutrophilia

Question 3

Causes of massive splenomegaly

Answer 3

Myeloproliferative disorders: CML, myelofibrosis

Infections: malaria, kala-azar aka visceral leishmaniasis

Question 4

Causes of moderate splenomegaly: 4-8cm

Answer 4

Infiltrative: amyloidosis, Gauchers

Myelo/lymphoproliferative disorders

Question 5

Causes of small splenomegaly: <4cm

Answer 5

Portal htn
Haemolytic anaemia: g6PD, hereditary spherocytosis
Infections: hepaticus, infective endocarditis, EBV
Myelo/lymphoproliferative

Question 6

Investigating splenomegaly

Answer 6

Abdominal USS

Haem: fbc, blood film, CT C+A, BM asp + trephine, LN biopsy
Infectious: viral serology, thick + thin films

Question 7

Indications for splenectomy

Answer 7

Trauma -> rupture
ITP
Hereditary spherocytosis

Question 8

Precautions for asplenic patients

Answer 8

Prophylactic penicillin
Vaccination v encapsulated organisms: 
meningococcus
pneumococcus
haemophilus influenzae