Splenomegaly

Definition

• Splenomegaly is the condition where the spleen becomes enlarged due to various reasons.
• The spleen is a vital organ located in the upper left region of the abdomen, playing a key role in filtering the blood and storing red blood cells.

Types

• Hypersplenism: A condition where the spleen becomes enlarged due to increased sequestration of blood cells and other factors.
• Hyperplastic: The spleen becomes enlarged due to the proliferation of its cells.
• Congestive: The spleen becomes enlarged due to increased venous pressure, often seen in conditions like congestive heart failure.
• Cystic: The spleen becomes enlarged due to the formation of cysts within it.
• Fibrotic: The spleen becomes enlarged due to the formation of fibrous tissue within it.

Causes

• Infections: Bacterial, viral, or parasitic infections such as malaria, mononucleosis, or tuberculosis.
• Blood disorders: Conditions like leukemia, lymphoma, or thrombocytopenia.
• Liver diseases: Conditions like liver cirrhosis or hepatitis.
• Cardiovascular diseases: Conditions like congestive heart failure.
• Hematological disorders: Conditions like sickle cell anemia.

Clinical Features

• Mass in the left upper quadrant: The spleen can be felt as a mass in the left upper quadrant of the abdomen.
• Pain and tenderness: Pain and tenderness in the left upper quadrant of the abdomen.
• Fatigue and weakness: Fatigue and weakness due to anemia.
• Petechiae and ecchymoses: Petechiae and ecchymoses due to thrombocytopenia.

Investigations

• Complete Blood Count (CBC): To identify anemia, leukocytosis, or thrombocytopenia.
• Blood smear: To identify abnormal blood cells or parasites.
• Liver function tests: To rule out liver diseases.
• Imaging studies: Ultrasound, CT scan, or MRI to visualize the spleen and rule out other conditions.

Complications

• Splenic rupture: Rupture of the spleen, which can be life-threatening.
• Infections: Infections of the spleen, which can be life-threatening.
• Anemia: Anemia due to the sequestration of red blood cells in the spleen.
• Thrombocytopenia: Thrombocytopenia due to the sequestration of platelets in the spleen.

Management

• Observation: Observation and monitoring for complications.
• Medications: Medications to manage symptoms, infections, or underlying conditions.
• Splenectomy: Surgical removal of the spleen in severe cases.

Treatment

• Antibiotics: Antibiotics to treat bacterial infections.
• Antiviral medications: Antiviral medications to treat viral infections.
• Antimalarial medications: Antimalarial medications to treat malaria.
• Splenectomy: Surgical removal of the spleen in severe cases.

Homoeopathic Therapeutic Medicines

• Arsenicum album: For anemia, fatigue, and weakness.
• Ferrum phosphoricum: For anemia, fatigue, and weakness.
• Calcarea carbonica: For infections, inflammation, and spleen enlargement.
• Lycopodium clavatum: For spleen enlargement, anemia, and fatigue.

Blood Supply

• The spleen is supplied by the splenic artery, which arises from the celiac trunk.

Nerve Supply

• The spleen is innervated by the splenic plexus, which is formed by branches from the celiac plexus.

Clinical Anatomy

• The spleen is located in the upper left region of the abdomen, behind the stomach and the diaphragm.
• The spleen is surrounded by the splenorenal ligament, which attaches it to the kidney.
• The spleen is also surrounded by the splenophrenic ligament, which attaches it to the diaphragm.

Splenomegaly

Anatomy and Physiology of Spleen Relevant to Splenomegaly

• The spleen is an organ that filters the blood and stores red blood cells.
• It is located in the upper left region of the abdomen.
• The spleen is surrounded by the diaphragm, stomach, and the left kidney.
• The spleen receives blood from the splenic artery and returns blood through the splenic vein.
• The spleen is innervated by the left gastric nerve, the left phrenic nerve, and the celiac plexus.

Causes of Splenomegaly

• Infectious diseases: malaria, typhoid, and viral infections.
• Blood disorders: anemia, leukemia, and lymphoma.
• Liver diseases: cirrhosis and liver failure.
• Cardiovascular diseases: heart failure and coronary artery disease.
• Autoimmune diseases: rheumatoid arthritis and lupus.
• Cancer: lymphoma, leukemia, and other cancers.

Clinical Manifestations

• Fullness in the left upper quadrant of the abdomen.
• Pain in the left upper quadrant of the abdomen.
• Signs of hypersplenism: anemia, thrombocytopenia, and leukopenia.

Diagnostic Workup

• Complete Blood Count (CBC)
• Liver function tests
• Imaging: ultrasound, CT scan, and MRI
• Bone marrow biopsy
• Splenic biopsy

Advanced Diagnostics

• Bone marrow biopsy: to diagnose bone marrow disorders.
• Splenic biopsy: to diagnose splenic disorders.
• MRI: to evaluate the spleen and surrounding structures.

Physical Examination

• Palpation: to feel the spleen.
• Percussion: to evaluate the spleen's size and tenderness.

Therapeutics for Splenomegaly

• Treatment of underlying cause.
• Medications to reduce spleen size.
• Splenectomy: surgical removal of the spleen.
• Radiofrequency ablation: to reduce spleen size.

Homoeopathic Therapeutic Medicines

• Arsenicum album: for anemia and splenomegaly.
• Phosphorus: for liver and spleen disorders.
• Calcarea carbonica: for anemia and fatigue.
• Ferrum phosphoricum: for anemia and spleen disorders.

Types of Splenomegaly

Hypersplenism

• Definition: excessive destruction of blood cells in the spleen.
• Causes: liver disease, portal hypertension, and autoimmune diseases.
• Clinical features: anemia, thrombocytopenia, and leukopenia.

Hypersplenism vs. Hypersplenism

• Hypersplenism: excessive destruction of blood cells in the spleen.
• Hypersplenism: decreased production of blood cells in the bone marrow.

Clinical Features of Hypersplenism

• Anemia: decreased red blood cell count.
• Thrombocytopenia: decreased platelet count.
• Leukopenia: decreased white blood cell count.

Diagnostic Criteria for Hypersplenism

• Anemia: hemoglobin < 10 g/dL.
• Thrombocytopenia: platelet count < 100,000/µL.
• Leukopenia: white blood cell count < 3,000/µL.

Complications of Splenomegaly

• Splenic rupture: tearing of the spleen.
• Splenic abscess: accumulation of pus in the spleen.
• Splenic torsion: twisting of the spleen.
• Splenic infarction: death of spleen tissue.

Management of Splenomegaly

• Treatment of underlying cause.
• Medications to reduce spleen size.
• Splenectomy: surgical removal of the spleen.
• Radiofrequency ablation: to reduce spleen size.