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Functions of the spleen

1. Produces opnonins
2. Produces IgM - capture and process foreign antigen
3. Filters capsulated microorganisms
4. Removes old blood cells and platelets
5. Recycles iron
6. Pools platelets 

Approach

• Expose as for abdomen examination 

Peripheral stigmata

• Anaemia - leuconychia, skin folds, mucous membranes
• Lymphadenopathy
• Stigmata of rheumatoid disease 

1. Inspect
   • Fullness underneath left costal margin
2. Palpate
   • Palpate in RIF moving to LUQ
   • Cannot "get above" spleen
   • Moves with respiration
   • Dull to percussion (underlies ribs 9-11) - 1x3x5 inches 7 ounces 9-11 ribs
   • Notch may be palpable on superomedial edge
   • Enlarges towards the umbilicus
   • Cannot be ballotted
3. Percuss
4. Auscultate 

 Completion

1. Examine the rest of the abdomen
2. Listen for heart murmurs - other features of infective endocarditis
3. Enquire about foreign travel, symptoms of possible haematological malignancy 

Causes of Splenomegaly

Or

1. Infective
   • Acute: EBV, CMV, HIV, Endocarditis
   • Chronic: Toxoplasmosis, malaria, brucella, leishmaniasis, schistosomiasis
2. Haematological
   • Haemolytic anaemia
   • Myeloproliferative disorders (myelofibrosis)
   • Sickle cell disease / thalassaemia
   • Leukaemia
   • Lymphoma
3. Portal hypertension
   • Cirrhosis
   • Hepatic, portal or splenic vein thrombosis
4. Systemic diseases
   • Amyloidosis
   • Sarcoidosis
   • Rheumatoid arthritis

Indications for splenectomy

1. Trauma
2. Hypersplenism (Autoimmune, hereditary spherocytosis, thrombotic thrombocytopenia, sickle cell, myelofibrosis)

Immunisations / treatements necessary in the event of performing splenectomy

1. Pneumococcal vaccine
2. HiB: Type B
3. Meningococcal vaccine
4. "flu" vaccine
5. Lifelong penicillin

Blood film appearance following splenectomy

1. Increased platelets (thrombocythaemia)
2. Increased neutrophils
3. Nucleated red cells with Howell-Jolly bodies
4. Target cells