Spleen Flashcards
what are the classifications of splenomegaly?
infections haematological disease portal hypertension metabolic and collagen disease cysts, abscess and tumours
what are the infectious causes of splenomegaly?
o Bacterial: typhus, typhoid, septicaemia
o Protozoal: malaria, kala-azar, Egyptian splenomegaly (schisyosomiasis)
o Parasitic: hydatid
what are the haematological disease causes of splenomegaly?
o Leukaemia: chronic myeloid and chronic lymphocytic
o Lymphoma: Hodgkin’s and non-Hodgkin’s lymphoma
o Myelofibrosis, idiopathic thrombocytopenia, polycythaemia rubra vera
o Haemolytic anaemias, for example spherocytosis, B-thalassemia
what is the pathophysiology of portal hypertension related splenomegaly?
Increased pressure in the portal system causes progressive enlargement of the spleen and may lead to hypersplenism with overactivity of the normal splenic functions such as removal of platelets, resulting in thrombocytopenia
what metabolic diseases are associated with splenomegaly?
o Amyloid: secondary to RA, collagen diseases, chronic sepsis
o Storage diseases: Gauchers disease
what is the CHICAGO acronym used for?
causes of splenomegaly
what does the CHICAGO acronym stand for?
- C – Cancer
- H – Haematological malignancies – anaemia, leukaemia, lymphoma,
- I – Infection (CMV, HEP, HIV, TB, parasitic (malaria)). EBV is the most common community acquired
- Inflammation – sarcoid, amyloid
- C – Congestion; portal hypertension
- A – Autoimmune (RA, SLE)
- G – Glycogen storage disorders
- O – Other – amyloidosis, sarcoidosis
what is the epidemiology of a ruptured spleen?
most common internal injury produced by non-penetrating trauma to the abdominal wall
what can cause a spontaneous splenic rupture?
spleen disease by malaria, glandular fever or leukaemia etc
what are the clinical features of splenic rupture?
Immediate massive bleeding
Peritonism from blood loss – tachycardia, hypotension, abdominal pain (diffuse or left flank), pain referral to left shoulder, tenderness, rigidity and guarding, bruising
Delayed rupture – pain followed by asymptomatic, formation of subscapular haematoma which will rupture = sharp, sudden
what investigations are done for ruptured spleen?
o Chest xray – fractures, diaphragm rupture
o Abdominal Xray
o US – free fluid, intrasplenic haematoma or laceratation of the capsule
o CT – investigation of choice
o Urinalysis
what is the management of a ruptured spleen?
o Resuscitation with blood replacement
o Laparotomy
o Dependent on damage, splenectomy
