In some patients, extensive radiological and laboratory investigations will fail to yield a diagnosis. Moreover, the examination should start with traube space percussion, followed, if dull, by supine 1handed palpation. The content on the uptodate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Also, a palpable left upper quadrant mass may indicate a problem other than an enlarged spleen such as a hypernephroma. The splenomegaly diagnosis was confirmed for the first time by us in 60% of the patients, ct in 27%, palpation in 10%, other method of examination 2%, and excision in 1%. Igm antibodies against malaria are detected in blood. Other functions include filtering senescent and defective red blood cells, presenting antigens to the immune system, and destroying. Evaluation of splenomegaly is notoriously difficult and embarrassingly easy to miss when present. Splenomegaly occurs in 1045% of patients, particularly during active disease.
In part this is because the spleen enlarges in the inferior anteromedial direction, sometimes as far as the rlq. The use of manual therapy or therapeutic touch has generated extensive literature. An overzealous palpation of the abdomen or a sudden blow can split the outer capsule of the spleen and cause bleeding into the abdominal cavity. Evaluation of splenomegaly differential diagnosis of. The spleen grows downwards and towards the right iliac fossa. This topic provides an overview of normal splenic size and function and an approach to evaluating splenic abnormalities in adults. Know the causes, symptoms, and treatment of splenomegaly. A 48 yearold woman with abdominal cramping, vomiting, and no bowel movement for 2 days. Spleen exam stanford medicine 25 stanford medicine. Jan 09, 2018 a multicentre observational study for early diagnosis of gaucher disease in patients with splenomegaly andor thrombocytopenia. The purpose of both palpation and percussion of the spleen is to look for splenic enlargement.
Physical examination size of the spleen hepatomegaly. The spleen is enlarged in a number of important clinical diagnoses. Splenomegaly in children see approach to the child with an enlarged spleen. Population for whom the physical examination of splenomegaly should be sought. Splenomegaly is a feature of a broad range of diseases, and presents to clinicians in many fields. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Splenomegaly is an enlargement of the spleen resulting from abnormalities of its lymphoid, reticuloendothelial, or vascular components. Jan 09, 2018 splenomegaly is defined as enlargement of the spleen, measured by size or weight. Splenomegaly is most often discovered under physical examination. The detection of an enlarged spleen is important in clinical diagnosis but seems to. However, in some people especially those who are slender a healthy, normalsized spleen can sometimes be felt during an exam. One third of neonates and one tenth of children may have a normal, palpable spleen. Splenomegaly is a sign of an underlying condition, such as severe liver disease, leukemia, or mononucleosis. The evaluation of splenomegaly in children and considerations related to elective or traumatic splenectomy are discussed separately.
Get a printable copy pdf file of the complete article 932k, or click on a page image below to browse page by page. Splenomegaly can be caused due to various medical conditions like some sort of an infection or problems with the liver. Splenomegaly and hypersplenism information page patient. If your institution subscribes to this resource, and you dont have a myaccess profile, please contact your librarys reference desk for information on how to gain access to this resource from offcampus. In cases in which splenomegaly is questioned, the clinical examination is more specific than sensitive and is best used when ruling in the diagnosis among patients for whom the suspicion is at least 10%. Evaluation of traubes space using a novel computerassisted method. Splenomegaly is defined as enlargement of the spleen, measured by size or weight. Causes of splenomegaly are myriad, as are the many possible ways of classifying them see table common causes of splenomegaly.
However, little is known about the prevalence and clinical significance of this finding in asymptomatic patients. The opening chapters deal with the preliminary general appraisal of the patient for a. However, when the tip of the spleen is felt beyond 2 cm below the left costal margin, it is considered abnormal. The pocket guide to physical examination and history taking. If confirmation of splenomegaly is necessary because the examination is equivocal, ultrasonography is the test of choice because of its accuracy and low cost. Splenomegaly hematology and oncology merck manuals. Splenomegaly general presentation the spleen is a hematopoietic organ supporting the megakaryotic, lymphoid, erythroid, myeloid, and reticuloendothelial systems. All structured data from the file and property namespaces is available under the creative commons cc0 license. Splenomegaly symptoms, diagnosis, treatments and causes.
Physical examination of the spleen is performed with the patient in. A systematic guide to physical diagnosis 7th edition pdf author nicholas j talley md nsw phd syd mmedsci clin epinewc. To determine whether sonographic versions of physical examination techniques can accurately identify splenomegaly. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. If your institution subscribes to this resource, and you dont have a myaccess profile, please contact your librarys reference desk for information on how to. Sep 09, 2016 during two evaluations of refugee populations in western uganda in march and july 2015, refugees with splenomegaly on physical examination were offered additional assessment and treatment, including abdominal ultrasonography and laboratory testing.
Splenomegaly american academy of pediatrics textbook of. Tuberculosis of the spleen as a cause of fever of unknown origin and splenmegaly. An enlarged spleen is usually detected during a physical exam. Pdf reliability of clinical techniques for detecting splenic. In the past, splenomegaly was a clinical finding, but in recent years, imaging studies have also helped to assess for or confirm mild splenomegaly. Files are available under licenses specified on their description page.
Splenomegaly is almost always secondary to other disorders. This condition as a whole is difficult to diagnose due to its. Physical diagnosis of the abdomen university of virginia. It enlarges towards the right iliac fossa rif always start palpation in the rif and move across towards the right upper quadrant or a massive splenomegaly may be missed. Introduction as early as the 17th century, it was realized that structural changes in the portal circulation could cause gastrointestinal bleeding. Splenomegaly increases the spleens mechanical filtering and destruction of red blood cells rbcs and often of white blood cells wbcs and platelets. We have a wonderfully rich tradition of physical diagnosis, and my hope is that this book will help square. Up to 3% of normal, thin, people have a palpable spleen. Kelley, textbook of internal medicine, 3rd edition, 1997. Physical diagnosis in medicine covers the procedures for physical examination and for diagnosis of common causes of abnormal physical signs. Splenomegaly is defined as enlargement of the spleen measured by weight or size.
Palpation and percussion of the spleen are important techniques for identifying an enlarged. Article pdf available in british medical journal 26043. Although splenomegaly is often considered to be an ominous clinical finding, certain normal variants have been found. Splenomegaly is abnormal enlargement of the spleen. Ct and mri may provide more detail of the organs consistency. Splenomegaly can be found in 3% of the normal population. One case was confirmed during explorative laparotomy, performed due to ileus. This means that splenomegaly, or a subtype of splenomegaly, affects less than 200,000 people in the us population. Your doctor may confirm the diagnosis of an enlarged spleen with one or. Patients with splenomegaly should avoid activities that risk trauma to the abdomen, including contact sports, because of risk of bleeding from the injured spleen. When considering whether an luq mass is an enlarged spleen, features of an enlarged spleen include that.
Your doctor can often feel it by gently examining your left upper abdomen. Describe how the physical examination affects the physicianpatient. A person with splenomegaly should take care to avoid all contact sports and any other activities that could potentially deliver a hard impact to their abdomen. Pdf comparing physical examination with sonographic versions. This book is distributed under the terms of the creative commons. It can be detected on physical examination by using castells sign, traubes space percussion or nixons sign, but an ultrasound can be used to confirm diagnosis. Enlarged spleen splenomegaly diagnosis and treatment. The term splenomegaly generally denotes a palpably enlarged spleen. Source diseases database splenomegaly is listed as a rare disease by the office of rare diseases ord of the national institutes of health nih. Does this patient have intestinal obstruction blockage of intestine. The spleen is a functionally diverse organ with active roles in immunosurveillance and hematopoiesis.
Tropical splenomegaly massive splenomegaly occurring in people of endemic area for malariakalaazar but no parasite is demonstrable in blood. What is splenomegalycausessymptomstreatmentdiagnosis. Pointofcare ultrasonography improves the diagnosis of splenomegaly in hospitalized patients. Assessing for the presence of splenomegaly is an important component of the physical examination. Cause of splenomegaly is obscurelymphocytic infiltration of splenic liver sinosoids present. A perfunctory examination while assuming the spleen is not going to be palpable is the best way to miss an enlarged spleen.
Although several methods of palpation and percussion of the spleen have been described, until recently they have not been validated by noninvasive imaging techniques such as ultrasonography, radionuclide scanning, and computed tomography that offer objective means to assess splenomegaly. Tuberculous splenomegaly with the hypersplenism syndrome. In patients where the likelihood of splenomegaly is high, the physical exam is not sufficiently sensitive to detect it. It is a reservoir for platelets and a site for the proliferation of blymphocytes. It has been found in up to 70% in a postmortem study. This book is composed of eight chapters that also outline the physical signs encountered in common medical conditions. This condition affects less than 1% of patients with rheumatoid arthritis. Morphologic approach microcytic anemia mcv splenomegaly is a frequent finding among hivinfected adults 1, 2. Jan 22, 2019 splenomegaly is a pathological condition in which spleen of an individual gets enlarged. Bates pocket guide to physical examination and history taking.
Mild to moderate splenomegaly may be recorded in the bilag index but not in other indices, such as sledai and eclam. Anatomy develops from condensations of mesoderm in the dorsal mesogastrium. In 1902, gilbert and carnot introduced the term portal hypertension to describe this condition. Full text full text is available as a scanned copy of the original print version. Hypersplenism is a secondary process that can arise from splenomegaly of almost any cause see table common causes of splenomegaly. Mri is especially useful in detecting portal or splenic vein thromboses. Olson ap, trappey b, wagner m, newman m, nixon lj, schnobrich d. The sensitivity for detection of ultrasounddocumented splenic enlargement is 60 to 70% for palpation and 60 to 80% for percussion. Splenomegaly causes of splenomegaly portal hypertension 33% chronic liver disease portalsplenic venous obstruction.
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