Classification, Causes, and Complications of Splenomegaly
Splenomegaly refers to enlargement of the spleen. Spleen is a visceral organ located just beneath the ribcage on left side. Splenomegaly may be asymptomatic or symptomatic, however, on physical examination, it is often demonstrated on palpation. The splenomegaly is classified according to Hackett’s Grading System. This system takes into account the extent of enlargement on spleen as demonstrated on physical examination. There are 6 grades of splenomegaly. Grade 0: Normal; no palpable spleen Grade 1: Spleen is palpable only during deep inspiration Grade 2: Spleen is palpable between umbilicus and costal margin in mid-clavicular line Grade 3: Spleen expands towards umbilicus Grade 4: Spleen is palpable beyond umbilicus Grade 5: Spleen expands towards pubic symphysis Splenomegaly may be present as essential component of various disease processes. Most common causes of splenomegaly are bacterial, viral, and parasitic infections, hemolytic anemias, myeloproliferative disorders, leukemia, cirrhosis, and metabolic diseases such as Niemann-Pick disease. Splenomegaly is associated with increased risk of rupture and infections. Due to decreased number of white blood cells, erythrocytes, and platelets, the risk of infection increases exponentially. The soft structure of spleen, particularly when enlarged, can get ruptured on minimum impact resulting in massive intra-abdominal hemorrhage and consequent shock. The management of splenomegaly is based on the treatment of underlying medial condition. Splenectomy may be the last resort in few disorders. Reference https://www.mayoclinic.org/diseases-conditions/enlarged-spleen/symptoms-causes/syc-20354326 https://www.slideshare.net/devrajpatel5/hypersplenism-its-surgical-management
Hypovolemic Shock