Splenomegaly

Causes of splenomegaly

Portal hypertension (33%)
- Chronic liver disease
- Portal/splenic venous obstruction; Budd-Chiari; heart failure
Haematological (30%)
- Lymphoproliferative (usually with nodes)
  - Leukaemias (AML, CML, ALL, CLL)
  - Lymphomas
- Myeloproloferative (usually without nodes)
- Haemolytic anaemias
  - Hb disorders: Thalassaemia, sickle cell disease (eventually leads to splenic atrophy)
  - Red cell structure: Spherocytosis/elliptocytosis
  - Enzyme: G6PD deficiency, pyruvate kinase deficiency

Infection
- Viral hepatitis
- EBV, CMV, HIV
- Bacterial
  - Infective endocarditis
- Foreign/tropical
  - Malaria
  - Schistosomiasis
  - Visceral leishmaniasis (Kala-azar)
- Tuberculosis, brucellosis
- Hydatid cyst
- Splenic abscesses
Infiltration
- Amyloidosis
Connective tissue disorders
- SLE
- RA (Felty’s syndrome: triad of RA, neutropenia and splenomegaly)
Splenic metastases
Genetic
- Gaucher’s disease, Niemann Pick, Histiocytosis X

Massive splenomegaly	Moderate splenomegaly	Mild splenomegaly
Myelofibrosis	Lymphoproliferative	PRV
CML	Portal hypertension	Haemolysis
Malaria	Thalassaemia	Infection
Visceral leishmaniasis	Glycogen storage disorders	Infiltration
		Connective tissue disorders

Presenting complaint
- Abdominal distension
- Abdominal pain
- Constitutional symptoms: nights sweats, fever, weight loss, malaise
- Abnormal bruising/bleeding
Past medical history
- Malignancy
- Connective tissue disease
Family history
- Malignancy
Social history
- Alcohol consumption
- Travel history
- Risk factors for viral hepatitis (see pages on viral hepatitis)

Anaemia
Lymphadenopathy
Signs of chronic liver disease
Splenomegaly (differentiation from kidney)
- Spleen has a medial notch, kidney doesn’t
- You can’t get above the spleen (ribs overly it)
- The spleen moves towards RIF with inspiration, the kidney moves posterior only (if at all)
- The spleen is not ballotable like the kidney