Causes of Splenic Enlargement

Study Notes

Infections:
- Bacterial: endocarditis, sepsis, and abscesses
- Viral: mononucleosis, cytomegalovirus, and hepatitis
- Parasitic: malaria, leishmaniasis, and schistosomiasis
Hematologic disorders:
- Hereditary spherocytosis
- Thalassemia
- Sickle cell disease
Inflammatory disorders:
- Rheumatoid arthritis
- Lupus
- Sarcoidosis
Cancer:
- Lymphoma (Hodgkin's and non-Hodgkin's)
- Leukemia
- Metastatic cancer
Other causes:
- Portal hypertension
- Cirrhosis
- Sickle cell disease

Physical examination:
- Palpation of the spleen
- Percussion to assess size
Imaging studies:
- Computed tomography (CT) scan
- Magnetic resonance imaging (MRI)
- Ultrasound
Laboratory tests:
- Complete blood count (CBC) to evaluate anemia and thrombocytopenia
- Blood smears to evaluate for abnormal red blood cells
- Liver function tests (LFTs) to evaluate for liver dysfunction

Splenic enlargement is often associated with liver disease, particularly:
- Portal hypertension
- Cirrhosis
- Liver cancer
The spleen may become enlarged due to:
- Portal hypertension causing increased blood flow to the spleen
- Increased production of cytokines and growth factors in liver disease
- Infiltration of the spleen by liver cancer cells
Splenic enlargement may also contribute to liver disease by:
- Sequestering platelets and red blood cells, leading to thrombocytopenia and anemia
- Impairing liver function by increasing portosystemic shunting

Infections can cause splenic enlargement, including bacterial infections such as endocarditis and sepsis, viral infections like mononucleosis and hepatitis, and parasitic infections like malaria and schistosomiasis
Hematologic disorders can also cause splenic enlargement, including hereditary spherocytosis, thalassemia, and sickle cell disease
Inflammatory disorders like rheumatoid arthritis, lupus, and sarcoidosis are also associated with splenic enlargement
Cancer, including lymphoma, leukemia, and metastatic cancer, can cause splenic enlargement
Other causes of splenic enlargement include portal hypertension, cirrhosis, and sickle cell disease

Many cases of splenic enlargement are asymptomatic
Left upper quadrant abdominal pain or discomfort is a common symptom
Early satiety, fatigue, weakness, anemia, easy bruising or bleeding are also common symptoms
Splenomegaly may be palpable on physical examination

Physical examination involves palpation of the spleen and percussion to assess its size
Imaging studies like CT scan, MRI, and ultrasound can help diagnose splenic enlargement
Laboratory tests like complete blood count (CBC) and blood smears can evaluate anemia and thrombocytopenia
Liver function tests (LFTs) can evaluate liver dysfunction

Splenic enlargement is often associated with liver disease, particularly portal hypertension, cirrhosis, and liver cancer
Portal hypertension can cause increased blood flow to the spleen, leading to splenic enlargement
Liver disease can also lead to increased production of cytokines and growth factors, contributing to splenic enlargement
Splenic enlargement can worsen liver disease by sequestering platelets and red blood cells, leading to thrombocytopenia and anemia
Splenic enlargement can also impair liver function by increasing portosystemic shunting