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Splenomegaly

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Whats problem of this

Tanzania patient?

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Spleenomagly and thrombus of portal vein

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Ultrasonography

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Su mma riza tio n of

normal spleenWeighs 200gNormally can not be palpated in LUQfilters the blood and removes abnormal

cells: old and defective red blood cellsProduces disease-fighting componentsof immune system

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Normally splenic dullnesspercussed between the9th and the 11thintercostal space alongleft midaxillary line

the scope 4-7cm without passing over left

anterior axillary line

percussion of the spleen

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left hand is placedover the patients leftcostovertebral angle,

exerting pressure tomove the spleenanteriorly.

right hand palpatesgently under the leftanterior costalmargin

Palpation of the spleen

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With the examiners hands stationaryin this position, the patient isinstructed to take a deep breath.

If there is a significant enlargementof the spleen, it will be palpated as afirm mass that slides out from under the ribs, bumping against the finger of the examiners right hand.

Palpation of the spleen

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Pa lp atio n of th e

spleen If the spleen is not

palpated, have thepatient roll on hisright side and repeatpalpation.

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Pa lp atio n of th e

spleen When the spleen can be felt, it must

be considered abnormal, since thenormal spleen is not palpable.

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Pa lp atio n of th e

spleenA moderately or greatly enlargedspleen --- bestdescribed by athree-line drawing

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Line 1: Thedistance

between leftcostal border and the lower edge of spleenalong leftmidclavicular line

Pa lp atio n of th e

spleen

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Line 2: The distancebetween the

crossing point of left midclavicular line and left costalborder and the most

remote point of thespleen

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Line 3: The distancebetween the rightborder of the spleenand the anterior midline. If the spleenindeed exceeds theanterior midline, Themark + is used toindicate exceeding,while is used toindicate notexceeding.

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Classification of

splenomegalylevel 2 (moderate enlargement

): the lower edge of spleen >2cm below the costal border butabove the umbilical horizontal line

chronic hemolytic( ) anemia,

hepatic cirrhosis, chroniclymphocytic leukemia(), lymphoma, chronic

infection

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Infectious and Inflammatory diseases :(1) virus infection : viral hepatitis,

infectious mononucleosis(), cytomegalovirus infection()

(2) Rickettsia Prowazeki or Rickettsiamooseri infection ( )epidemic typhus and endemic typhus( )

Etiology and pathogenesis

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Et io lo gy a nd

pathogenesis(3) bacterial infection : sepsis, miliary(

) tuberculosis, splenicabscess

(4) leptospira ( ) infection(5) parasitic infection : malaria,

schistosomiasis

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Et io lo gy a nd

pathogenesisNon- inflammatory diseases

Splenic congestion cirrhosis (hepatic cirrhosis with portalhypertension, splenic veinocclusion (thrombosis), Budd-

Chiari Syndrome, or congestiveheart failure with increased venouspressure)

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Et io lo gy a nd

pathogenesis Hematological diseases hemolytic(

) anemia, Myelofibrosis( ),

leukemia, lymphoma Connective tissue diseases SystemicLupus Erythematosus, Rheumatoidarthritis, dermatomyositis( )polyarteritis nodosa

Others splenic cyst, angioma( )

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Tumor of spleen

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Hematoma of spleen

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Hematoma of spleen

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Differential diagnosis

Common problem: enlarged spleen andleft kidney

Ranal tumors: deeper,roundedposteriorly, never have a distinct edgePalpation can helpUltrasonography or CT can make thedistinction

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Renal tumor

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,examiner puts his left handbelow left rib cage, at the

costospinal angle, and lifts up.Examiner uses his right hand topalpate deeply from umbilical

level in the left midclavicularline, and moves progressivelyupward. The lower pole of the

kidney may be felt as a smooth,round, and deep structure thatmoves relatively little withrespiration. i h kid

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right kidney. Normally the kidney is not

palpated. Sometimes the lowerpole of the right kidney may befelt in normal patients.

During deep inspiration, if more than half of the kidney ispalpated, nephroptosis( )

is considered. Repeat the maneuver with thepatient in sitting and standing

positions if you wish to expose

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Your Attention Your AttentionThanks for Thanks for