Gastroenterology Book

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Splenomegaly

Aka: Splenomegaly, Spleen Enlargement
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  1. See Also
    1. Asplenism
    2. Hepatomegaly
    3. Splenomegaly in Newborns
  2. Causes: Infectious
    1. Bacterial Infection
      1. Subacute Bacterial Endocarditis
      2. Brucellosis
      3. Syphilis
      4. Typhoid
      5. Tuberculosis
      6. Rocky Mountain Spotted Fever
      7. Lyme Disease
    2. Fungal Infection
      1. Toxoplasmosis
      2. Histoplasmosis
    3. Parasitic Infection
      1. Malaria
      2. Leishmaniasis
      3. Schistosomiasis
    4. Viral infection
      1. Epstein-Barr Virus infection (Mononucleosis)
      2. Cytomegalovirus
      3. HIV Infection
      4. Viral Hepatitis
      5. Malaria
  3. Causes: Malignancy
    1. Leukemia
    2. Lymphoma
    3. Melanoma
    4. Sarcoma
    5. Pancreatic Cancer
    6. Myelofibrosis
  4. Causes: Hematologic
    1. Hemolytic Anemia
    2. Thalassemia major
    3. Hereditary Spherocytosis
    4. Sickle Cell Anemia and other Hemoglobinopathy
    5. Megaloblastic Anemia (e.g. Pernicious Anemia)
    6. Polycythemia Vera
  5. Causes: Miscellaneous
    1. Liver disease with secondary Portal Hypertension
    2. Congestive Heart Failure
    3. Systemic Lupus Erythematosus
    4. Rheumatoid Arthritis (Felty's Syndrome)
    5. Langerhan's Cell Histiocytosis
    6. Gaucher's Disease
    7. Hyperthyroidism
    8. Sarcoidosis
    9. Intravenous Drug Abuse
  6. Signs
    1. Spleen exam: Right lateral decubitus position
      1. Best position to examine enlarged Spleen
      2. Note splenic size in cm below left costal margin
      3. Castell's Point percussion (best Negative Likelihood Ratio)
        1. Percuss point at mid-axillary line at last intercostal space
        2. Dull to percussion in cases of Splenomegaly (if hollow sound then rules-out diagnosis)
        3. Palpate below costal margin to confirm
    2. Lymphadenopathy
  7. Labs
    1. Complete Blood Count
    2. Peripheral Smear
      1. Howell Jolly bodies (seen in Asplenism)
      2. Thrombocytopenia (seen in splenic hyperfunction)
  8. Radiology
    1. Splenic Ultrasound
    2. Abdominal CT (evaluate splenic masses)
    3. Gallium Scan (suspected Lymphoma or infection)
    4. Technetium liver-Spleen scan (comorbid liver disease)
  9. Evaluation
    1. Step 1: Confirm Splenomegaly
      1. Select imaging study (usually CT or Ultrasound)
    2. Step 2: Evaluate for hematologic or infectious cause
      1. Consider Complete Blood Count and Peripheral Smear
    3. Step 3: Evaluate for cardiovascular cause
      1. Consider Liver Function Tests and Echocardiogram
      2. Causes
        1. Liver disease with Portal Hypertension
        2. Congestive Heart Failure
        3. Subacute Bacterial Endocarditis
    4. Step 3: Evaluate for autoimmune causes
      1. Consider sedimentation rate, ANA, RF
      2. Causes
        1. Systemic Lupus Erythematosus
        2. Rheumatoid Arthritis
    5. Step 4: Evaluate Bone Marrow
      1. Consider Bone Marrow Biopsy with culture
    6. Step 5: Splenectomy if symptomatic
  10. References
    1. Armitage in Goldman (2000) Cecil Medicine, p. 960-2
    2. Degowin (1987) Diagnostic Examination, p. 508-11
    3. Ferri (2004) Clinical Advisor, p. 1173 and p. 1330

Splenomegaly (C0038002)

Definition (NCI) Enlarged spleen.
Definition (MSH) Enlargement of the spleen.
Definition (NCI) Abnormal enlargement of the spleen.
Definition (CSP) enlargement of the spleen.
Concepts Finding (T033)
MSH D013163
ICD9 789.2
ICD10 R16.1
SnomedCT 207235005, 207234009, 207236006, 16294009, 158516000, 158518004, 158517009
English Splenomegaly, SPLEEN ENLARGED, SPLEEN ENLARGEMENT, SPLENOMEGALY, Enlargement of spleen, NOS, Splenomegaly, NOS, [D]Spleen enlargement (context-dependent category), [D]Splenomegaly (context-dependent category), [D]Splenomegaly NOS (context-dependent category), Spleen enlargement, Splenomegaly NOS, [D]Spleen enlargement, [D]Splenomegaly, [D]Splenomegaly NOS, Enlarged spleen, Unspecified splenomegaly, splenomegaly (physical finding), enlarged spleen, splenic enlargement, splenomegaly, spleen enlargement, [D]Splenomegaly (situation), [D]Spleen enlargement (situation), Spleen enlarged, [D]Splenomegaly NOS (situation), Enlarged Spleen, Spleen, Enlarged, Splenomegaly [Disease/Finding], enlarg spleen, Enlarged;spleen, enlargement spleen, spleen enlarged, spleen large, splenomegali, enlargement of spleen, large spleen, Enlargement of spleen, Large spleen, Splenomegaly (disorder)
French SPLENOMEGALIE, AUGMENTATION DE VOLUME DE LA RATE, Splenomegalie, Splénomégalie, Hypertrophie de la rate, Hypertrophie splénique
Portuguese ESPLENOMEGALIA, Baço aumentado, AUMENTO DE VOLUME DO BACO, Esplenomegalia, Baço Aumentado
Spanish ESPLENOMEGALIA, Bazo agrandado, [D]esplenomegalia, SAI (categoría dependiente del contexto), [D]agrandamiento del bazo (categoría dependiente del contexto), [D]esplenomegalia (categoría dependiente del contexto), [D]Splenomegaly, [D]Spleen enlargement, BAZO AUMENTADO DE TAMANO, [D]esplenomegalia, SAI (situación), [D]esplenomegalia, SAI, [D]esplenomegalia (situación), [D]agrandamiento del bazo (situación), [D]agrandamiento del bazo, [D]esplenomegalia, agrandamiento del bazo, esplenomegalia (trastorno), esplenomegalia, Esplenomegalia, Bazo Agrandado
German SPLENOMEGALIE, Milz vergroessert, MILZVERGROESSERUNG, Splenomegalie, Milzvergrößerung, Vergrößerte Milz
Dutch vergrote milt, splenomegalie, Splenomegalie, Miltvergroting, Vergrote milt
Italian Milza ingrandita, Splenomegalia
Swedish Mjältförstoring, FORSTORAD MJALTE
Japanese ﾋｼｭ, ﾋｼｭﾀﾞｲ, 巨大脾, 巨脾症, 巨大脾症, 巨脾, 脾腫, 脾腫大, 脾腫脹, 脾臓腫大
Czech splenomegalie, Splenomegalie, Zvětšená slezina
Finnish Splenomegalia, SPLENOMAGIALIA/SUURENTUNUT PERNA
Russian SPLENOMEGALIIA, СПЛЕНОМЕГАЛИЯ
Norwegian FORSTORRET MILT
Danish Forstorret milt
Croatian SPLENOMEGALIJA
Basque ESPLENOMEGALIA
Hebrew hagdalat hatxol
Polish Splenomegalia
Hungarian splenomegalia, Lép megnagyobbodott
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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