Station 1 - Spleen Flashcards
List clinical signs of splenomegaly
- Anaemia
- Lymphadenopathy (axillae, cervical and inguinal areas)
- Purpura
Describe splenomegaly, what else should be checked?
LUQ mass that moves inferomedially with respiration, medial notch, dull to percuss and cant get above nor ballot
- estimate size
- check for hepatomegaly
If lymphadenopathy is found with splenomegaly, what underlying causes should be considered?
-Haematological and infective
If stigmata of chronic liver disease is found with splenomegaly, what underlying causes should be considered?
-Cirrhosis with portal hypertension
If splinter haemorrhages/murmur are found with splenomegaly, what underlying causes should be considered?
-Bacterial endocarditis
If rheumatoid hand changes are found with splenomegaly, what underlying causes should be considered?
Felty’s syndrome
What are the causes of massive splenomegaly?
> 8cm
- myeloproliferative disorders (CML and myelofibrosis)
- Tropical infections (malaria, visceral leishmaniasis - kala-azar)
What are the causes of moderate splenomegaly?
4-8cm
- Myelo-lymphoproliferative disorders
- infiltration (gauchers and amyloidosis)
What are the causes of spleen tip splenomegaly?
<4cm
- myelo-lymphoproliferative disorders
- Portal hypertension
- infections (EBV, Infective endocarditis, and infective hepatitis)
- Haemolytic anaemia
What investigations are indicated for splenomegaly with a haematological cause?
US abdo
- FBC and film
- CT CA
- Bone marrows aspirate and trephine
- lymph node biopsy
What investigations are indicated for splenomegaly with an infective cause?
US abdo
- thick and thin films (malaria)
- Viral serology
What are the indications for splenectomy?
- Rupture (trauma)
- Haematological (ITP and hereditary spherocytosis)
What is the medical work up for splenectomy?
- Vaccination ideally 2 weeks prior (pneumococcus, meningococcus, haemophilus influenzae)
- prophylactic penicillin
- Medic alert bracelet
