Lymphadenopathy: Splenomegaly – White Blood Cell Pathology

00:02 Let’s take a look at splenic pathology.

00:04 With splenomegaly, remember passive congestion.

00:09 Remember the portal vein is being formed by the splenic vein and the superior mesenteric vein.

00:13 So therefore anytime that you would expect there to be what’s known as portal hypertension, you’d expect there to be splenomegaly, cirrhosis, portal vein thrombosis or heart failure.

00:25 What kind of heart failure may result in splenomegaly? Take your time, use common sense.

00:31 Right-sided heart failure, right? Back up into liver and then eventually back up into spleen, splenomegaly.

00:39 Passive congestion.

00:41 What else may cause splenomegaly? Well, infiltration.

00:46 Lymphoproliferative diseases are important and now at this point, it would be in your best interest to know the anatomy of your spleen.

00:55 And this is a weak area for a lot of medical students along with the lymph node as well.

01:01 But at least know that there might be marginal zone lymphoma, an actual cancer that might be taking place in your spleen resulting in left upper quadrant fullness.

01:13 Storage diseases may result in splenic distention or perhaps even amyloidosis.

01:19 Amyloidosis really does not spare any organ per se.

01:23 Any organ is pretty much at risk of being damaged with amyloidosis.

01:31 Splenomegaly in terms of infection.

01:35 You’ve heard of kissing disease.

01:37 In developed countries in which you have a child that has gone on to college and maybe partying at a fraternity and so forth, maybe passing beers, meaning to say that they might be passing EBV.

01:49 Epstein-Barr virus is then going to affect your child resulting in mononucleosis.

01:54 And with that type of infectious mononucleosis, at some point in time, by far, what you’re worried about here is splenomegaly.

02:02 And at some point in time, if there’s trauma, that is experienced by this young male, young female, there might be splenic rupture and resulting in massive intraperitoneal hemorrhage, bleeding and perhaps even, well, hypovolemic shock.

02:19 Hypersplenism, what does it mean to you? Whenever there is spleen that is undergoing increased functioning or it is being enlarged, there could be congestion of blood in the spleen causing sequestration of blood elements resulting in, well, anemia.

02:35 At times, there might be increased activation of your spleen depending as to what the needs will be.

02:41 Both processes leads to – well, if there’s sequestration of blood components, maybe it’s sequestering your RBCs, welcome to anemia.

02:50 Maybe it’s sequestering platelets, welcome to thrombocytopenia.

02:54 And your patient is going to present with bleeding.

02:57 In some cases, there is a risk of traumatic splenic rupture, which we talked about.

03:01 And that hemoperitoneum or the massive loss of blood may result in hypovolemic shock or perhaps even potentially fatal.