SPLENOMEGALY
Definition:-
• Splenomegaly is defined by increased splenic dimensions and volumes.
• Spleen diameters averaged over 13 cm and an area above 45 cm² or wright above 400 g consider as splenomegaly.
Classification:-
• Splenomegaly can be classified as;
• Mild
• Moderate
• Massive
Mild splenomegaly
• Just palpable (palpation does not guarantee splenomegaly)
• 1-3 cm more than normal
Spleen =14-16cm.
• Spleen >400 g 400g 8 cm
• Spleen >1000 g
• Splenic area > 65 cm²
Causes of splenomegaly:-
• Splenomegaly due to exaggerated forms of normal splenic function;
• Infective – infection or inflammatory processes results from an increase in the defense activities of organ.
• Hyperplastic – Removal of abnormal blood cells from the circulation is the usual source of hyperplastic splenomegaly.
• Congestive – cirrhosis with portal hypertension, splenic vein occlusion or congestive heart failure (CHF) causes congestive splenomegaly.
• Infiltrative – infiltrative splenomegaly is the result of swelling of macrophages with indigestible material.
• Cysts
• Hemangiomas
• Other malformation
• Several Diseases can lead to splenomegaly, anemia, Malaria etc.
Mild splenomegaly (1-3cm)
• Acute Malaria
• Typhoid
• Kala-azar
• Septicemias
• SLE
• Infective endocarditis
• Rheumatoid arthritis
• HIV
• Thalassemia minor
• Miliary TB
• CCF
Moderate splenomegaly (4-8cm)
• Viral hepatitis
• Cirrhosis
• Lymphomas
• Amyloidosis
• Splenic abscess, infarct
• IMN
• Hemolytic anemias
• Polycythemias
• Hemochromatosis
Massive splenomegaly (>1000gm or >8cm)
• CML
• CLL
• Lymphomas
• Hairy like leukemia
• Myelofibrosis With myeloid metaplasia
• Chronic malaria
• Kala -Azar (tropical splenomegaly)
• Sarcoidsis
• AIHA
• Diffuse splenic hemangiomatosis
Sign and symptoms:-
• Fever
• Left upper quadrant pain
• Full Ness and early satiety
• Feeling of heaviness in left upper quadrant
• Yellowing of skin and eyes
• Blood clot in legs
• Fatigue
• Easy bleeding
• After eating Small amount of the enlarged spleen pressing on the stomach
• Hiccups because of diaphragm irritation
• Pain radiate from upper Abdomen to back or shoulder blade
• Shortness of breath
• Heavy menstruations
Diagnosis:-
• Physical examination
Most practical and cost effective method
• Laboratory investigation
o CBC
o Peripheral smear study
o Liver function test
o Reticulocytes count
o Serology ( viral , parasites)
o Coagulation profile
o Blood c/s
• Imaging examination
o Computed tomography
o Magnetic resonance imaging
o Ultrasonography
HOMOEOPATHIC MANAGEMENT
1) CEANOTHUS AMERICANUS:-
The only sphere of action of this remedy seems to be in splenic trouble. It indications are deep-seated pain in the splenic region, deep stitches like pain ,worse in damp weather, with enlargement of the spleen. Chronic pain in the spleen . pain in left with shortness of breath.
2) CINCHONA OFFICINALIS :-
This remedy corresponds to congestion , pain in region of the spleen with swelling of spleen, splenomegaly. Dull aching pain in region of spleen, Hyperaemia of spleen. Nervous system sensitive, physical or mental effort aggravates the complain . amelioration by bending double , pressure and open air.
3) CAPSICUM:-
One of the most efficient remedies for sensitive swollen and enlarged spleen. Burning, spasmodic constriction and all other pains are worse between the act of degulutition.
4) BRYONIA ALBA :-
Pain in left side .pain gets worse on physical activity or from slightest motion and relieves at absolute rest . Swollen spleen accompanied by constipation and craving of salt . excessive thirst for large quantity of cold water at long intervals. Dryness of all mucus membranes.
5) ARSENICUM ALBUM:-
It is also used in enlargement of spleen. Great weakness both mentally as well as physically. Early satiety of felling of fullness without eating or eating of food. Abdominal bloating due to abdominal compression in this symptoms. Burning pain in whole over the body, and it’s relived by heat except head. Symptoms are aggravated at mid-day and mid-night.
6) Lachesis:-
Spleen and liver region sensitive can not bear anything tight around waist ,suited to drunkards during climacteric age and melancholic disposition ,ill effect of suppressed discharges. All Symptoms are worse after and during sleep. Great loquacity, wants to talk all time, but without any relevancy .
7) Iodum :-
Used in enlargement of spleen, liver. All the glands / lymphatic mesenteric of the body become enlarged except of mane that dried up. Feeling hungry all the times, eat too much but body remain thins .pain during empty Abdomen. Complaints Ameliorate with cold applications and drinks.
AUTHOR :
DHARTI PATEL
3 RD YEAR B.H.M.S
MENTOR :DR SHAILAJA SHETH
ASSISTANT PROFESSOROF DEPARTMENT OF SURGERY
PARUL INSTITUTE OF HOMOEOPATHY AND RESEARCH
