| The term "splenomegaly" refers to abnormal enlargement of the spleen, an abdominal organ that is part of the lymph system and has many immune system and circulatory functions. The spleen plays a key role in manufacturing antibodies to fight inflammation and infection, cleansing the blood of foreign material, and producing red and white blood cells. Because of its wide variety of functions, the spleen may be affected by many conditions involving the blood or lymph system; bacterial, viral and parasitic infections; malignancies; and liver disease.
The enlargement may be due to one or more of the following conditions: cirrhosis of the liver; infectious inflammatory diseases such as mononucleosis and hepatitis; chronic infections such as syphilis, tuberculosis, and malaria; diseases of the bone marrow; hemolytic anemias; cancers such as leukemia, lymphoma and Hodgkin's disease; diseases of the metabolic system; cystic fibrosis; biliary atresia; sclerosing cholangitis; Wilson's Disease; Banti's syndrome; liver disease; primary thrombocytosis; or trauma. However, in nearly 5% of individuals with enlarged spleens, no underlying cause can be determined.Risk: Women are twice as likely as men to get tropical splenomegaly, and enlarged spleens occur more often in older people (Kaplan). Incidence and Prevalence: Recent studies revealed that 2% to 5.6% of individuals have a large spleen on physical exam; in Africa, tropical splenomegaly is very common (Kaplan). |
Source: Medical Disability Advisor
| History: Individuals may report a history of chronic or acute infectious disease, inflammatory and connective tissue disorders, or liver conditions. They may complain of left upper quadrant abdominal pain; early appetite satisfaction (feeling full immediately upon eating); and recent, unintentional weight loss. Physical exam: Physical exam may reveal signs and symptoms of an infectious or inflammatory process, such as fever, rapid heart rate, fatigue, tender and/or swollen lymph nodes, and abdominal distention. The edge of the spleen may be felt (palpated) when examining the left upper abdomen. Abnormal swooshing sounds (bruits) may be heard when using a stethoscope to listen (auscultate) over the region of the spleen. Tests: Laboratory tests include blood chemistries, bone marrow examination, and complete blood and platelet count. Imaging studies include ultrasound, CT scan, abdominal x-ray, splenic scan with technetium, and splenic uptake studies. A biopsy of the spleen may be done if cancer is suspected; because the spleen tends to bleed profusely, the biopsy is usually done in association with an open surgical exploration of the abdomen (exploratory laparotomy) and partial or total removal of the spleen (splenectomy). A reliable biopsy cannot be obtained via laparoscopic splenectomy because the tissue is damaged when removed through the laparoscope. |
Source: Medical Disability Advisor
| Most individuals with splenomegaly require treatment for the underlying disease. Medical interventions such as administration of medications for underlying infections and possible radiation therapy (to shrink the enlarged organ) are used as appropriate. The spleen is surgically removed (splenectomy) only via open abdominal surgery (laparotomy) when medically necessary, when it is markedly enlarged, and when other treatments are not effective. A splenectomy may also be done to assess the rate of disease progress (staging) if it is cancerous. |
Source: Medical Disability Advisor
| Outcome can be good for splenomegaly associated with acute infections that have been adequately treated or poor, depending upon the underlying disease process and treatment required. Those whose splenomegaly is associated with chronic conditions such as immune system depression or cancer tend to have a poorer outcome. However, due to the wide range of conditions associated with splenomegaly, it is impossible to determine the exact outcome for those with splenomegaly. Surgical outcomes following splenectomy are usually good. Those who have underlying bleeding disorders may have more bleeding complications; they usually resolve quickly once the spleen is removed. Individuals who have a complete splenectomy will be susceptible to sudden death from infectious causes, and should receive proper immunization for pneumococcus, influenza, hepatitis, and meningococcemia. |
Source: Medical Disability Advisor
| Complications relate to the underlying condition responsible for the splenomegaly. Spontaneous rupture of an enlarged spleen is rare; however, such ruptures can result in massive bleeding and shock. Enlarged spleens may easily rupture and bleed during laparoscopy. In general, spleens that rupture during laparoscopy are promptly removed (splenectomy), which eliminates the source of the bleeding and minimizes the risk for shock. Postsplenectomy infection has a very high death rate of 50% to 70%; it falls to 10% if the individual receives antibiotic treatment quickly (Kaplan). Death from bacterial sepsis may occur years after a splenectomy. |
Source: Medical Disability Advisor
| Work restrictions and accommodations are made based on the underlying condition, the type of treatment required, and the individual's physical response to treatment. Anyone with an enlarged spleen is at risk for its accidental rupture and possible hemorrhage. Consequently, strenuous activity, contact sports, and heavy lifting should be avoided until the spleen returns to a normal size or is removed. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has diagnosis of splenomegaly been confirmed?
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Have other conditions (tumors in the left upper abdomen or fluid in the abdomen (ascites) been ruled out?
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Has the cause of spleen enlargement been identified?
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Is underlying condition being appropriately addressed?
Regarding treatment:
- Have medical interventions, such as rest, good nutrition, administration of medications for underlying infections, and possible radiation therapy, been successful?
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If surgical intervention was necessary, for what purpose was the splenectomy performed? Were any complications associated with the procedure?
Regarding prognosis:
- Have underlying conditions responded favorably to treatment?
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If symptoms persist despite treatment, does diagnosis need to be revisited?
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Has condition for which splenectomy was performed improved or resolved with removal of spleen?
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What additional therapy may be required?
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Is individual compliant with vaccinations for pneumococcus, influenza, hepatitis, and meningococcemia?
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Source: Medical Disability Advisor
| Kaplan, Lewis J., and David Coffman. "Splenomegaly." eMedicine. Eds. Wadie F. Bahou, et al. 5 Oct. 2004. Medscape. 29 Dec. 2004 <http://emedicine.com/med/topic2156.htm>. |
Source: Medical Disability Advisor
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