221. Red Pulp, White Pulp - An approach to splenomegaly
Jan 21, 2024
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Dr. Gizelle Popradi, a hematologist, and Dr. Samuel Mamane, a general internist, discuss the physiology, etiology, and treatment of splenomegaly. They cover topics such as different causes of splenomegaly, diagnostic approaches, treatment options including chemotherapy and surgical interventions, and the importance of identifying underlying causes for appropriate management.
Splenomegaly can have diverse etiologies including infectious, neoplastic, and inflammatory causes.
Spleen evaluation involves clinical exams and diagnostic workup including imaging studies and laboratory tests for proper treatment planning.
Deep dives
Overview of Spleen Function and Composition
The spleen is the largest lymphatic organ in the human body, situated in the posterior left upper quadrant of the abdomen near the stomach, colon, and left kidney. Comprising red pulp and white pulp components, it plays crucial roles in hematologic functions, such as filtering and storing platelets, and immunologic responses involving lymphocytes and macrophages.
Etiologies of Splenomegaly
Splenomegaly can stem from various causes categorized into congestive, infectious, hematologic, immunologic, neoplastic, inflammatory, and infiltrative origins. These include conditions like portal hypertension, viral infections (e.g., Epstein-Barr virus), neoplasms such as lymphomas, and inflammatory disorders like collagen vascular diseases.
Clinical Assessment and Management of Splenomegaly
Clinical evaluations for splenomegaly involve history-taking for symptoms like left upper quadrant fullness, along with physical examinations, including inspection, percussion, and palpation to detect spleen enlargement. Diagnostic workup entails imaging studies like ultrasound, laboratory tests such as complete blood count and liver function testing, and consideration of treatment options based on the underlying cause, ranging from addressing infections to chemotherapy or surgical interventions like splenectomy in specific cases.
In this episode, we review the physiology and pathophysiology, etiology, clinical exam, investigations and treatment in patients with splenomegaly. Our medicine minute addresses the COMFORT II trial published in the New England Journal of Medicine in 2012.
Written by: Drs. Owen Luo and Jia Li (Lily) Liu (Internal medicine residents) Reviewed by: Dr. Gizelle Popradi (hematologist) and Dr. Samuel Mamane (general internist)