Splenomegaly

Question 1

Splenomegaly WITHOUT enlarged LNs

Answer 1

Myeloproliferative disease - CML, myelofibrosis

Question 2

Splenomegaly WITH enlarged LNs

Answer 2

Lymphoproliferative disease - lymphoma and CLL

Question 3

Characteristics of spleen

Answer 3

Enlarges towards RIF, possesses a medial notch, dull to percussion, not ballotable, one cannot palpate above

Question 4

Causes

Answer 4

Portal hypertension 33%
Haematological malignancy 27%
Infection 23%
Congestion or inflammation 8%
Primary splenic disease 4%

Question 5

Massive splenomegaly

Answer 5

CML
Myelofibrosis
Visceral leischmaniasis
Malaria
AIDS

Question 6

Moderate splenomegaly

Answer 6

Portal hypertension
Lymphoma
Leukaemia
Thalassaemia
Glycogen/lipid storage

Question 7

Mild splenomegaly

Answer 7

Other myeloproliferative disorders
Haemolysis
Infection
Autoimmune
Infiltrative

Question 8

Investigation

Answer 8

Full history
Bloods
CT scan
BM biopsy

Question 9

B symptoms

Answer 9

Fever >38, weight loss >10% body weight over 6 months, drenching night sweats

Question 10

CML genetics

Answer 10

Philadelphia chromosome - bcr-abl - chromosome 9 and 22 –> tyrosine kinase

Question 11

Causes of hyposplenism

Answer 11

Splenic infarction
Splenic artery thrombosis
Infiltrative conditions
Coeliac disease
Autoimmune disease

Question 12

Management of hyposplenism

Answer 12

Vaccinations - pneumococcal, HiB, meningitis C
Prophylactic antibiotics

Question 13

Felty’s

Answer 13

RA, neutropenia and splenomegaly