tailieunhanh - Chapter 060. Enlargement of Lymph Nodes and Spleen (Part 5)

Approach to the Patient: Splenomegaly Clinical Assessment The most common symptoms produced by diseases involving the spleen are pain and a heavy sensation in the LUQ. Massive splenomegaly may cause early satiety. Pain may result from acute swelling of the spleen with stretching of the capsule, infarction, or inflammation of the capsule. For many years it was believed that splenic infarction was clinically silent, which at times is true. However, Soma Weiss, in his classic 1942 report of the self-observations by a Harvard medical student on the clinical course of subacute bacterial endocarditis, documented that severe LUQ and pleuritic chest. | Chapter 060. Enlargement of Lymph Nodes and Spleen Part 5 Approach to the Patient Splenomegaly Clinical Assessment The most common symptoms produced by diseases involving the spleen are pain and a heavy sensation in the LUQ. Massive splenomegaly may cause early satiety. Pain may result from acute swelling of the spleen with stretching of the capsule infarction or inflammation of the capsule. For many years it was believed that splenic infarction was clinically silent which at times is true. However Soma Weiss in his classic 1942 report of the self-observations by a Harvard medical student on the clinical course of subacute bacterial endocarditis documented that severe LUQ and pleuritic chest pain may accompany thromboembolic occlusion of splenic blood flow. Vascular occlusion with infarction and pain is commonly seen in children with sickle cell crises. Rupture of the spleen from either trauma or infiltrative disease that breaks the capsule may result in intraperitoneal bleeding shock and death. The rupture itself may be painless. A palpable spleen is the major physical sign produced by diseases affecting the spleen and suggests enlargement of the organ. The normal spleen is said to weigh 250 g decreases in size with age normally lies entirely within the rib cage has a maximum cephalocaudad diameter of 13 cm by ultrasonography or maximum length of 12 cm and or width of 7 cm by radionuclide scan and is usually not palpable. However a palpable spleen was found in 3 of 2200 asymptomatic male freshman college students. Follow-up at 3 years revealed that 30 of those students still had a palpable spleen without any increase in disease prevalence. Ten-year follow-up found no evidence for lymphoid malignancies. Furthermore in some tropical countries . New Guinea the incidence of splenomegaly may reach 60 . Thus the presence of a palpable spleen does not always equate with presence of disease. Even when disease is present splenomegaly may not reflect the primary disease