SPLENOMEGALY, ACUTE OR SUBACUTE

Ask the Following Questions:

1. Is there fever? The presence of fever should suggest infectious mononucleosis, infectious hepatitis, leptospirosis, acute leukemia, lymphoma, malaria, and bacterial endocarditis, among other things.
2. Is there a rash? The presence of a rash should suggest thrombocytopenic purpura, acute leukemia, typhoid fever, septicemia, and lupus erythematosus.
3. Is there jaundice? The presence of jaundice should suggest infectious hepatitis, leptospirosis, malaria, hereditary spherocytosis and other hemolytic anemias, and portal vein thrombosis secondary to chronic liver disease.
4. Is there lymphadenopathy? The presence of lymphadenopathy should suggest infectious mononucleosis, acute lymphatic leukemia, lymphoma, brucellosis, and reticuloendotheliosis.
5. Is there a history of trauma? The presence of a history of trauma would suggest a traumatic rupture of the spleen.

DIAGNOSTIC WORKUP

Routine tests include a CBC, platelet count, sedimentation rate, chemistry panel, febrile agglutinins, serum haptoglobins, ANA test, Monospot test, serum protein electrophoresis, tuberculin test, chest x-ray, EKG, and flat plate of the abdomen.

If there is jaundice, a hepatitis profile, red cell fragility test, and blood smear for parasites should be done. If there is fever, serial blood cultures, leptospirosis antibody titer, and smear for malarial parasites should be done. If there is a petechial rash, a coagulation profile should be done. Lymph node biopsies and bone marrow examinations may be necessary. A CT scan of the abdomen and radionuclide scan for liver and spleen size and ratio should be done. The assistance of a hematologist or infectious disease expert should be sought. A surgeon may need to be consulted for an exploratory laparotomy.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

More About Causes of Swollen spleen

• Back to symptom: Swollen spleen: Introduction (review 1237 causes)
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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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