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06-08-2008, 07:24 AM
(I) Clinical Investigations:
Common Causes:
1- Bilharzial spleen: See before.
2- Malarial spleen: Endemic area, History of fever & rigors.
3- Leukaemic spleen: ( ch. Lymphatic leukaemia).
Spleen may be directed to Lt. iliac fossa due to soft capsule.
Lymphadenopathy, liver enlargement.
Bone pain & tenderness over the sternum (by direct percussion).
Anaemia and spontaneous hemorrhage.
4- Hodgkin's lymphoma:
Spleen is rubbery in consistency with rounded border.
Anaemia, itching and Pel-Ebestein fever.
Lymphadenopathy (Discrete & rubbery).
5- Acholuric jaundice: (Spherocytosis).
Intermittent course. Anaemia with mild jaundice.
Haemolytic crises may be percipitated by stress, infection, trauma.
6- Idiopathic thrombocytopenic purpura:
Intermittent course.
Haemorrhagic tendency manifestation bleeding/orifices, subcutaneous & submucus .
7- Splenic abscess, cysts or tumours.
Sonar and C.T. Scanning can help diagnosis.
(II) Laboratory Investigations:
1- Urine and stool analysis: for Bilharziasis.
2- Blood examination:
Diagnostic for leukaemia. Blood film for malaria may be +ve.
Decrease platelet count in 1ry purpura.
Biconvex R.B.C.S. in spherocytosis.
3- Sternal puncture: Diagnostic for leukaemia.It must be done for every case of splenomegaly with lymphadenopathy.
4- Liver function tests: In cases with enlarged liver.
5- Liver biopsy: It may detect type of cirrhosis.
(III) Investigations for Portal Hypertension:
1- Barium swallow: Multiple smooth filling defects {Oesoph. varices}.
2- Splenoportography: (percutaneous)
A needle is introduced to spleen untill blood freely comes.
Diodrast is injected to delinate splenic vein, portal vein and vascular tree inside the liver. It may show:
a- Obstruction to the flow outside the liver thrombosis. Inside the liver fibrosis.
b- New porto systemic communications: e.g. reversal of the dye to the left gastric vein towards the oesophagus to azygus system.
3- Measurement of portal tension:
Pre-operative per cutaneus trans-splenic manometry.
Operative direct connection of the manometer to one of veins of greater omentum.
The normal portal bl. pr is 8-12 mmHg.
4- Oesophagoscopy:
Of great help in diagnosis of oesophageal varices.
SOURCE: DR. AYMAN SALEM'S BOOK
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