[vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][ultimate_heading main_heading=”Candidate brief” main_heading_color=”#000000″ sub_heading_color=”#000000″ main_heading_style=”font-weight:bold;” main_heading_font_size=”desktop:36px;”]

“This patient presented to the acute medical unit on account of pyrexia.  Please examine the patient’s abdomen and then discuss your findings with the examiners.”

[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/208486316″][vc_empty_space image_repeat=”no-repeat”][vc_row_inner row_type=”row” type=”full_width” use_row_as_full_screen_section_slide=”no” text_align=”left” css_animation=””][vc_column_inner width=”1/4″][no_counter type=”zero” box=”no” position=”center” underline_digit=”no” separator=”yes” digit=”20″ title=”Minutes” text=”Station time”][/vc_column_inner][vc_column_inner width=”1/4″][no_counter type=”zero” box=”no” position=”center” separator=”yes” digit=”10″ title=”Minutes” text=”Time for this encounter”][/vc_column_inner][vc_column_inner width=”1/4″][no_counter type=”zero” position=”center” separator=”yes” digit=”6″ title=”Minutes” text=”Maximum time to examine your patient”][/vc_column_inner][vc_column_inner width=”1/4″][no_counter type=”zero” position=”center” separator=”yes” digit=”4″ title=”Minutes” text=”Minimum time for discussion and questions”][/vc_column_inner][/vc_row_inner][vc_empty_space image_repeat=”no-repeat”][/vc_column][/vc_row][vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][vc_accordion style=”accordion”][vc_accordion_tab title=”Common examiner questions”][vc_column_text]Common examiner questions include the following:

  1. What do you think this patient has?
  2. How would you like to investigate this patient next?
  3. What do you think the underlying cause of this patient’s signs is?

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Diagnosis and clinical signs”][vc_column_text]This patient has a probable haematological or viral pathology leading to splenomegaly and generalised lymphadenopathy.

The clinical signs exhibited in this video include:

  • Moderate splenomegaly;
  • Cervical lymphadenopathy;
  • Inguinal lymphadenopathy.

Note is also made of an old appendicectomy scar and subtle abdominal striae.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Discussion”][vc_column_text]

Clinical Picture:

A wide variety of diseases are associated with splenomegaly, or enlargement of the spleen, with many of the mechanisms leading to this condition due to exaggerated normal spleen function. The spleen is not palpable in normal instances but is palpable if enlarged.

The causes range from malignancy, infections, congestion, infiltration of the spleen with other diseases, inflammatory conditions and blood cell disorders, hence splenomegaly usually has very vague symptoms. Abdominal pain and bloating are most common. A very large spleen may present as early satiety (anorexia) and gastric reflux due to compression by the enlarged spleen.
Other symptoms are associated with the underlying cause of enlargement.

Initial Investigation:

Spleen enlargement can be detected on abdominal palpation. However, mostly spleen enlargement is detected incidentally on some imaging study like CT scan for some other disease. Abdominal ultrasound is also useful in detecting an enlarged spleen. All other investigations are based on the underlying disease causing splenomegaly. For example a full blood count and a blood smear to detect blood disorders like anemia, CML, malaria.

Underlying Pathology:

Pathology of an enlarged spleen depends on the underlying disorder. A few causes for splenomegaly are: liver diseases (chronic hepatitis C, alcoholism), blood cancers (leukemias, myelofibrisis), infections (mononucleosis, malaria), congestion (splenic vein thrombosis, congestive heart failure), blood cell disorders (sickle cell anemia), gaucher’s disease, inflammatory disease (lupus), idiopathic thrombocytopenic purpura, polycythemia vera .

Treatment:

In many conditions, the spleen enlarges a result of performing its normal physiologic function in response to another medical condition, for example, cirrhosis. The main objective is then not necessarily to improve splenomegaly that is a consequence of the disease, but to treat the underlying cause, such as cirrhosis. Hence the treatment is to treat the underlying cause.
Occasionally, the indicated treatment is surgical removal of the spleen (splenectomy) in order to control the causative conditions. Some conditions in which splenectomy may be considered are hairy cell leukemia, thalassemia major, splenic vein thrombosis, Gaucher disease, and ITP. A careful consideration of risks versus benefits of surgery is the most prudent approach. Wherever possible it is advisable to vaccinate prior to splenectomy as removal of the spleen impairs the ability of the patient to respond to T independent antigens such as polysaccharide.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Specimen case presentation”][vc_column_text]”This patient clinically has splenomegaly.  I palpated a mass in the left upper quadrant that moved with respiration and had a palpable notch.  To investigate the patient next I would like to arrange some baseline venous bloods.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]