Splenomegaly – A practical approach

 

Splenomegaly or in other words increased spleen represents an important objective sign that the physician must consider if during physical examination of abdominal palpation feel tumor changed boundaries of authority in the area of the left costal arch. In such a case the doctor is the one to consider why and where such a change occurred in the body. But above all it must satisfy itself that the increased spleen is a consequence of a previous illness such as malaria or subacute bacterial endocarditis.

Splenomegaly is a condition that commonly occurs as a result of another disease. So often the consequence or complication of something original that is usually secondary condition and therefore from the outset to solve the riddle should not think immediately that it is initially increased, and that is the primary condition for as such is very rare. With below described practical examples of its diagnosis.

In case of acute febrile condition followed by splenomegaly, the physician should consider the presence of abdominal typhoid, paratyphoid or infectious mononucleosis, and if physical examination is not good enough as a result of inexperience or deconcentration doctor would automatically think of pneumonia or flu, because diseases they also go by the highly elevated temperature. But splenomegaly can occur as a result of heart error, that could be a consequence of subacute bacterial endocarditis.

In this condition you should always do a complete blood count because he would be found out whether it is due to a hematologic disease. Despite a complete blood count must be examined and liver function (determination of bilirubin, serum protein, thymol, transaminases, etc.), because splenomegaly often goes with a simultaneous increase in the liver or hepatomegaly (portal hypertension). It is therefore very important in such a good condition to determine the limits and the liver and spleen.

The size of the spleen plays a very important role in the interpretation of what could cause such a condition. Very large spleen can be found in cases of leukemia mileoidna, myelosclerosis, kala azar, chronic malaria, congestive splenomegaly, and lymphosarcoma in tezaurizmozite example Gosherovata disease. Also spleen may be enlarged and limfogranulomatoznite Bolsena, polycythemia rubra vera and endocarditis tape. In case of acute infectious conditions spleen never large-scale and mostly in healing not palpable.

If the increase in spleen remain dilemma, it is necessary to make certain diagnostic procedures such as:

  • Qunkcija lymph node (finding of Leishmania donovani / kala azar, a finding of Reed-Sternberg-s cells / NHL).
  • Sternal puncture(finding of Leishmania donovani; diagnosis of Gaucher cells, cells of multiple myeloma – plasma cell myeloma).
  • Puncture of the spleen(a finding of Leishmania donovani; diagnosis of Gaucher cells, cells of lymphosarcoma or retikulosarkom; finding of Reed-Sternberg-s cells;

Sometimes after the diagnostic procedures performed, the cause of splenomegaly remains undiscovered. Some patients also live for years and it can be healthy without any subjective symptoms. Although such patients are unchecked, increased spleen is a result of previous infection.