Splenomegally

1 hour

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 Objectives
1. Describe different causes of splenomegally.
2. Explain pathogenesis of different causes of
splenomegally.

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 Outlines
• Anatomy
• Function of the spleen
• Causes
• Clinical presentations

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 Surgical Anatomy
• It is a wedge-shaped organ lying mainly in left
hypochondrium, along the long axis of 10th
rib.
• Hilum of spleen transmits splenic vessels and
nerves.
• The visceral surface is related to stomach,
splenic flexure of colon, kidney.

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 Diagram of spleen

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 Accessory Spleen locations

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Surgical Anatomy cont…
• Spleen is suspended by two ligaments
(a) Lienorenal ligament,
(b) Gastrosplenic ligament.
• Lienorenal ligament transmits blood vessels to
spleen.
• The gastrosplenic ligament contains short gastric
vessels which supply the left half of greater curvature
of stomach.

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Surgical Anatomy…
Blood Supply
• Splenic artery is the branch of coeliac artery but may
arise from aorta or superior mesenteric artery, blood
flow is 300 ml/min.

• Splenic vein joins the superior mesenteric vein at right

angle behind the neck of pancreas to form the portal
vein.
• Splenic parenchyma contains white pulp and red pulp.

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 Functions of spleen
• Response to antigenic challenge
• Destruction or correction of abnormal cells
like old RBC’s.
• Phagocytosis of foreign substances
• As platelet reservoir.
• Erythrocyte production.
• Iron reutilisation.

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 Splenomegaly
• Simply....enlargement of the spleen

• Splenomegally vs hypersplenism

• Etiology is diverse but may results from;

– Increased splenic activity
– Decreased venous drainage
– Infiltration of the spleen
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 Splenomegaly cont..
• Increased splenic activity
– Compensatory extramedullary hematopoesis within
the spleen due to conditions involving bone marrow
deficiency
– Decreased venous drainage.e.gPHTN.
– Splenic infiltration
– Suppression of splenic tissue
– Increased degradation of defective or structurally
abnormal cells.
– Increased immune response
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 Causes of Splenomegaly
• Infective: Tuberculosis, splenic abscess e.t.c
• Blood diseases: Chronic myeloid leukaemia, myelo
fibrosis
• Metabolic: Gaucher’s disease, amyloidosis,
porphyrias,
• Portal hypertension.
• Collagen diseases.
• Malignancy: Hodgkin’s lymphoma, splenic
sarcomas.

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 Massive splenomegally
• Massive is the spleen that is palpable more than 8 cm
below the costal arch, >20cm diameter and/or weight
> 1000g
– CLL and CML
– Myelofibrosis
– Polycethemia vera
– Rarely hairy cell leukemia, HL and non HL

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 Clinical features of enlarged spleen
• Mass in the left hypochondrium
• Notch is felt
• Moves with respiration
• Dull on percussion
• Directed towards right illiac fossa
• Cannot insunuate finger under left costal
margin

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Masses which mimic splenomegaly
• Kidney mass(left kidney)
• Retroperitoneal mass
• Left colonic mass
• Left adrenal mass

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 Hypersplenism
• An overactive spleen
• Increased splenic activity
• Clinical features
– Enlarged spleen
– Low levels of one or more types of blood cells;
• Anaemia
• Thrombocytopemia
• Leukopenia
• Pancytopenia
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 Summary
• Simply....enlargement of the spleen
• Etiology is diverse
• An overactive spleen may be an indication of
splenectomy.

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 References
• Bailey & Love’s, SHORT PRACTICE of
SURGERY 27th Edition.

• Schwartz’s Principles of Surgery,11th Edition

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