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MRCP PACES Abdomen > Splenomegaly > Flashcards

Splenomegaly Flashcards

1
Q

What are the causes of splenomegaly?

A 
Commonly encountered in exam:
1. Haematological malignancy
2. Portal hypertension
3. Haemolytic anaemic
4. Felty's syndrome
5. Thalassaemia
  1. Portal hypertension
  2. Haematological malignancy
  3. Infection (HIV, endocarditis, EBV)
  4. Congestion (cardiac failure)
  5. Primary splenic disease (splenic vein thrombosis)
  6. Haemolysis
  7. Thalassaemia
  8. Glycogen storage disorders
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2
Q

History taking in a patient with splenomegaly

A
  1. Constitutional symptoms - fever, night sweats, malaise, weight loss
  2. Risk factors for HIV
  3. Risk factors for lymphoma - family history, radiation therapy, immunosuppressive, organ transplant
  4. Bone and joint pain - secondary hyperuricaemia, myeloproliferative disease
  5. Pancytopenia - bruising, fatigue, recurrent infection
  6. Travel history, malaria risk, prophylaxis
  7. Autoimmune disease
  8. Liver disease
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3
Q

What are the significance of B-symptoms on Hodgkin’s lymphoma?

A

Presence of any these alters the patient’s clinical staging:
1. Fever > 38 degree
2. Weight loss >10% body weight in 6 months
3. Drenching night sweats

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4
Q

What are the cytogenetics of chronic myeloid leukaemia?

A

Philadelphia chromosome present in 90-95% of patients with CML
Chromosomal translocation - fusion of c-abl oncogene of chromosome 9 with bcr on chromosome 22.
–> Increased oncogene activity through tyrosine kinase signalling

Detection of bcr-abl gene for diagnosis and tyrosine kinase monoclonal antibodies for treatment

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5
Q

What are the causes of hyposplenism?

A
  1. Splenic infarction (sickle cell, vasculitis)
  2. Splenic artery thrombosis
  3. Infiltrative conditions (amyloidosis, sarcoidosis)
  4. Coeliac disease
  5. Autoimmune disease
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6
Q

What advice should patients with hyposplenism/post-splenectomy be given?

A
  1. Vaccinations (pneumococcal, haemophillus influzena B and meningococcal group C), repeat every 5-10 years
  2. Prophylactic antibiotics - penicillin or erythromycin for 2 years +/- lifelong
  3. Malaria prophylaxis and travel advice
  4. Red flag symptoms for hospitalisation
  5. Medic alert card or bracelet
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7
Q

What is Felty’s syndrome?

A

Triad of seropositive arthritis, neutropaenia and splenomegaly

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8
Q

What are the indications for splenectomy?

A

Rupture

Haematological (ITP, hereditary spherocytosis)

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9
Q

What are the causes of massive splenomegaly?
(Defined as crossing midline, > 8cm from left costal margin)
(M: CML-AMK)

A
  1. CML
  2. Myelofibrosis
  3. Lymphoma
  4. AIDS with mycobacterium avium complex
  5. Malaria
  6. Kala-azar
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10
Q

What are the causes of moderate splenomegaly?
(size 4-8cm from left costal margin)
(M: A-GPT)

A
  1. All causes of massive splenomegaly
  2. Glycogen and lipid storage disease (Gaucher’s disease)
  3. Portal hypertension
  4. Thalassaemia
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11
Q

What are the causes of mild splenomegaly?
(size: <4cm from left costal margin)

A
  1. Other myelo/lymphoproliferative disorders - PRV
  2. Haemolytic anaemia
  3. Infection (EBV, infective endocarditis, infective hepatitis)
  4. Autoimmune disease (RA, SLE)
  5. Infiltrative disease (amyloidosis, sarcoidosis)
  6. Acromegaly
  7. Thyrotoxicosis
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12
Q

What are the characteristics of spleen on palpation?

A
  1. Enlarges towards right iliac fossa
  2. Has a medial notch
  3. Dull to percussion
    (Kidneys are resonant - retroperitoneal due to overlying colon)
  4. Cannot palpate above the spleen
  5. Not ballotable
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13
Q

Investigations for splenomegaly

A
  1. Blood: FBC, PBF, LFT, LDH, autoimmune screen, B2M
  2. CXR
  3. HIV testing
  4. Imaging
    - Ultrasound HBS and spleen
    - CT TAP: for disseminated malignancy, lymph node
    - PET
  5. Bone marrow and lymph node biopsy
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14
Q

Approach to Splenomegaly

A
  1. Size of splenomegaly
    - Typical spleen: 12cm length, only palpable once >15cm
    - Subtle changes - dull percussion over Traube space (usually resonant from stomach)
    - Size determines possible etiologies
    - Differentiating signs from polycystic kidney
  2. Pancytopenia
    - Anaemia: conjunctival pallor
    - Thrombocytopenia: easy bruising
    - Lymphopenia: infection related signs
  3. Hyperbilirubinaemia +/- pruritus
    - Without hepatomegaly -> haemolytic anaemia (AIHA, CLL)
    - With hepatomegaly -> thalassaemia, chronic liver disease, malignancy
  4. Stigmata of chronic liver disease
    - Positive -> possible portal hypertension as cause of splenomegaly
    - Venous hum over epigastrium
  5. Lymphadenopathy
    - Positive -> lymphoproliferative disorder or Felty’s syndrome
    - Negative -> myeloproliferative disorder but ask for imaging to evaluate
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MRCP PACES Abdomen (14 decks)

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