Splenomegaly

Question 1

What are the causes of splenomegaly in order of frequency

Answer 1

Portal hypertension -33%
Haematological malignancy - 27%
Infection - 23%
CCF - 8%
Primary splenic disease - 4% (e.g. splenic vein thrombus)
Other - 5%

Question 2

What are the causes of massive splenomegaly (crosses midline)

Answer 2

CML
Myelofibrosis
Kala-azar - visceral leishmaniasis
Malaria
Aids with mycobacterium avium

Question 3

What are the causes of moderate splenomegaly

Answer 3

Portal hypertension
Lymphoma
Leaukaemia
Thalassaemia
Glycogen/lipid sotrgae disease

Question 4

What are the causes of mild splenomegaly

Answer 4

Other myeloproliferative disease - e.g. Polycythaemia

Haemolysis

Infection - EBV, infective endocarditis

Autoimmune disease - RA/feltys, SLE

Infiltrative - amyloid, sarcoidosis

Question 5

Which conditions can cause splenomegaky without hepatomegaly

Answer 5

Autoimmune disease e.g. SLE
Primary splenic disease e.g. splenic abscess

Haematologoical malignancies (Note - all haematological malignancies can cause 
hepatomegaly due to extramedullary haematopoeisis)

Question 6

What are the characteistics of the spleen on palpation

Answer 6

Enlarges towards RIF
Has a medial notch
Dull to percussion (kidney is resonant)
Cannot get above the spleen 
Not ballotable

Question 7

What is the cause of splenomegaly without lymphadenopathy

Answer 7

Portal hypertension

Myeloid proliferative conditions - e.g. - CML - spleen is more likely to be massive and anaemia is more common

(Not lymphoproliferative disorders e.g. lymphoma, CLL - spleen is not as enlarged
- hepatomegaly is more common

Question 8

What are the causes of hyposplenism

Answer 8

Splenic infarction - sickle cell, vasculitis

Splenic artery thrombosis

Infiltrative conditions - amyloid, sarcoid

Coeliac disease

Autoimmune disease