Splenomegaly

Explanation of what splenomegaly is in relation to its dimension deviation from normal spleen.Classification of splenomegaly according to it's size in adult and pediatric. The causes of splenomegaly along with the symptom that would manifest as a result of this anomaly. Lastly, diagnosis of splenomegaly

1. Splenomegaly _Ramzee Small

2. OUTLINE Splenomegaly Definition Classification Etiology Symptom Diagnosis References

3. Splenomegaly Splenomegaly is defined by increased splenic dimensions and volume. Spleen diameters averaged over 13 cm and an area above 45 cm 2 or weight above 400 g are considered splenomegaly.

4. Splenomegaly Normal Spleen Splenomegaly

5. Classification Splenomegaly can be classify as; Mild Moderate Massive

6. Classification Mild Splenomegaly Just palpable (palpation does not guarantee splenomegaly) (1-3) cm more than normal spleen 14cm - 16 cm Spleen > 400 g < 1000 g   Mild Splenomegaly with Cirrhosis

7. Classification Moderate Splenomegaly Between costal margin & umbilicus ( 4-8) cm more than normal spleen 17 cm – 21 cm Spleen > 400 g <1000 g Splenic Area 45 cm 2 -65 cm 2  

8. Classification Massive Splenomegaly Beyond umblicus , crosses mid line into pelvis Spleen > 8cm than normal Spleen > 1000g Splenic area > 65 cm 2

9. Pediatric Splenomegaly Splenomegaly (Splenic Length) Age Group >6.0 cm 3 months >6.5 cm 6 months >7.0 cm 12 months >8.0 cm 2 years >9.0 cm 4 years >9.5 cm 6 years >10.0 cm 8 years >11.0 cm 10 years >11.5 cm 12 years >12.0 cm 15 years

10. Etiology S plenomegaly due to exaggerated forms of normal splenic function; Infective - infections or inflammatory processes results from an increase in the defense activities of the organ Hyperplastic - Removal of abnormal blood cells from the circulation is the usual source of hyperplastic splenomegaly. Congestive - Cirrhosis with portal hypertension, splenic vein occlusion or congestive heart failure (CHF) causes congestive splenomegaly Infiltrative - Infiltrative splenomegaly is the result of swelling of macrophages with indigestible materials.

11. Etiology Cysts , H emangiomas , O ther malformations . Several diseases can lead to splenomegaly; malaria, anemias etc.

12. Symptom Associated symptoms or signs are typically related to the underlying disorder. Fever Left Upper Quadrant pain (splenic infarct) (localize area of dead cell) Fullness and early satiety Feeling of heaviness in LUQ Jaundice

13. Diagnosis Physical Examination Most practical and cost effective method Laboratory Investigation Perform a complete blood count (CBC) with differential, platelet count, and peripheral blood smear Imaging Examination Computed Tomography Magnetic Resonance Imaging, Ultrasonography ( High sensitivity & specificity, safe , noninvasive, quick, mobile, and less costly)

14. Ultrasound Diagnosis o f Splenomegaly Splenic Dimensions Splenic Contour (Rounded Edge) Dilated Splenic vein (> 9 mm ) Normal Spleen - Homogenous, slightly hyperechoic, with mild-to-low echogenicity compare to liver, a smooth contour.

15. Diagnosis Massive Splenomegaly Mild irregular contour and inhomogeneous echo-structure with diffuse hyperechoic foci suggesting small infarctions

16. Diagnosis Splenomegaly with Splenic Vein Dilation

17. Diagnosis Computed Tomography Ultrasound Magnetic Resonance Imaging

18. Conclusion I f the spleen is minimally enlarged, may be followed with careful and regular observation. Patients with enlarged spleens are more likely to have splenic rupture from blunt abdominal or low thoracic trauma . Splenomegaly most likely result in splenectomy

19. References Swaoop J, O’Reily RA. Splenomegaly at a University Hospital compared to a nearby county hospital in 317 patients. Acta Haematol 1999;102:83-8. Ioanitescu S, Iliescu L, Harza M, Ismail G, Copaci I. Ultrasound of the spleen, EFSUMB Course Book;1-46. Published by EFSUMB, 2012. Radhakrishnan N, Besa,C , E. Splenomegaly. Medscape. 2018 January 09;1-9 World Health Organisation, World Federation for Ultrasound in Medicine and Biology: Manual of Diagnostic ultrasound; 2003