Asplenia physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Asplenia}} | {{Asplenia}} | ||
{{CMG}} {{AE}}{{ | {{CMG}} {{AE}} {{Kalpana Giri}} | ||
==Overview== | ==Overview== | ||
[[physical]] findings depend on the [[associated]] [[anomalies]]. Patients with [[sickle cell disease]], especially [[children]] may have [[enlarged]] spleen. Physical exam features typically include [[Cyanosis]], [[Cold extremities]], [[Stiff neck]], [[Breathlessness]], [[Pan-systolic murmur]], [[Pre-cordial bulge]], [[Ejection systolic murmur]], [[Right sided apex beat]], [[Abdominal tenderness]]. | |||
==Physical Examination== | ==Physical Examination== | ||
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*Other [[physical]] findings depend on the [[associated]] [[anomalies]]. | *Other [[physical]] findings depend on the [[associated]] [[anomalies]]. | ||
*In [[isolated congenital asplenia]], for [[diagnosis]], there are no other [[physical clues]] and [[overwhelming infection]] may be the first [[sign]] of the [[disease]].<ref name="pmid29254492">{{cite journal| author=Iijima S| title=Sporadic isolated congenital asplenia with fulminant pneumococcal meningitis: a case report and updated literature review. | journal=BMC Infect Dis | year= 2017 | volume= 17 | issue= 1 | pages= 777 | pmid=29254492 | doi=10.1186/s12879-017-2896-5 | pmc=5735542 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29254492 }} </ref> | *In [[isolated congenital asplenia]], for [[diagnosis]], there are no other [[physical clues]] and [[overwhelming infection]] may be the first [[sign]] of the [[disease]].<ref name="pmid29254492">{{cite journal| author=Iijima S| title=Sporadic isolated congenital asplenia with fulminant pneumococcal meningitis: a case report and updated literature review. | journal=BMC Infect Dis | year= 2017 | volume= 17 | issue= 1 | pages= 777 | pmid=29254492 | doi=10.1186/s12879-017-2896-5 | pmc=5735542 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29254492 }} </ref> | ||
*In patient with [[sepis]] [[physical exam]] was notable for [[lethargy]], [[irritable]], [[dry mucous membrane]].<ref name="pmid31703560">{{cite journal| author=Albrecht T, Poss K, Issaranggoon Na Ayuthaya S, Triden L, Schleiss KL, Schleiss MR| title=Case report of congenital asplenia presenting with Haemophilus influenzae type a (Hia) sepsis: an emerging pediatric infection in Minnesota. | journal=BMC Infect Dis | year= 2019 | volume= 19 | issue= 1 | pages= 947 | pmid=31703560 | doi=10.1186/s12879-019-4572-4 | pmc=6842177 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31703560 }} </ref> | |||
* | |||
===Vital Signs=== | ===Vital Signs=== | ||
*Patients with [[asplenia]] usually appear [[normal]]. The following variations can be seen in Asplenia infected by invasive bacterial infection. The following signs can be noticed in patients with asplenia infected by invasive bacterial infection.<ref name="pmid31703560">{{cite journal| author=Albrecht T, Poss K, Issaranggoon Na Ayuthaya S, Triden L, Schleiss KL, Schleiss MR| title=Case report of congenital asplenia presenting with Haemophilus influenzae type a (Hia) sepsis: an emerging pediatric infection in Minnesota. | journal=BMC Infect Dis | year= 2019 | volume= 19 | issue= 1 | pages= 947 | pmid=31703560 | doi=10.1186/s12879-019-4572-4 | pmc=6842177 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31703560 }} </ref> | |||
* | *[[Fever]] | ||
*[[ | *[[Tachycardia]] with [[regular pulse]] | ||
*[[Tachycardia]] with regular pulse | *[[Tachypnea]] | ||
*[[ | *[[Hypotention]] | ||
* | |||
===Skin=== | ===Skin=== | ||
[[Cyanosis]] may be present in congenital asplenia with visceral heterotaxy with bilateral right-sidedness.<ref name="pmid18564289">{{cite journal| author=Thiruppathy K, Privitera A, Jain K, Gupta S| title=Congenital asplenia and group B streptococcus sepsis in the adult: case report and review of the literature. | journal=FEMS Immunol Med Microbiol | year= 2008 | volume= 53 | issue= 3 | pages= 437-9 | pmid=18564289 | doi=10.1111/j.1574-695X.2008.00422.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18564289 }} </ref> | *[[Cyanosis]] may be present in [[congenital asplenia]] with [[visceral heterotaxy]] with [[bilateral]] [[right-sidedness]].<ref name="pmid18564289">{{cite journal| author=Thiruppathy K, Privitera A, Jain K, Gupta S| title=Congenital asplenia and group B streptococcus sepsis in the adult: case report and review of the literature. | journal=FEMS Immunol Med Microbiol | year= 2008 | volume= 53 | issue= 3 | pages= 437-9 | pmid=18564289 | doi=10.1111/j.1574-695X.2008.00422.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18564289 }} </ref> | ||
*[[Cold extremities]] in [[sepsis]]. <ref name="pmid29254492">{{cite journal| author=Iijima S| title=Sporadic isolated congenital asplenia with fulminant pneumococcal meningitis: a case report and updated literature review. | journal=BMC Infect Dis | year= 2017 | volume= 17 | issue= 1 | pages= 777 | pmid=29254492 | doi=10.1186/s12879-017-2896-5 | pmc=5735542 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29254492 }} </ref> | |||
=== | |||
===Neck=== | ===Neck=== | ||
* Neck examination of patients with [[asplenia]] is usually normal. | * Neck examination of patients with [[asplenia]] is usually normal. In [[Right-sided isomerism]] or [[Heterotaxy syndromes]] with [[complex cardiac anomalies]], [[dysphagia]] may be present.<ref name="pmid22470785">{{cite journal| author=Agarwal H, Mittal SK, Kulkarni CD, Verma AK, Srivastava SK| title=Right isomerism with complex cardiac anomalies presenting with dysphagia--a case report. | journal=J Radiol Case Rep | year= 2011 | volume= 5 | issue= 4 | pages= 1-9 | pmid=22470785 | doi=10.3941/jrcr.v5i4.702 | pmc=3303439 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22470785 }} </ref> | ||
*[[Stiff neck]] in fulminant [[pneumococcal meningitis]].<ref name="pmid29254492">{{cite journal| author=Iijima S| title=Sporadic isolated congenital asplenia with fulminant pneumococcal meningitis: a case report and updated literature review. | journal=BMC Infect Dis | year= 2017 | volume= 17 | issue= 1 | pages= 777 | pmid=29254492 | doi=10.1186/s12879-017-2896-5 | pmc=5735542 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29254492 }} </ref> | |||
===Lungs=== | ===Lungs=== | ||
[[Respiratory distress]] may be present in [[congenital asplenia]] with [[visceral heterotaxy]] with [[bilateral]] [[right-sidedness]]. <ref name="pmid18564289">{{cite journal| author=Thiruppathy K, Privitera A, Jain K, Gupta S| title=Congenital asplenia and group B streptococcus sepsis in the adult: case report and review of the literature. | journal=FEMS Immunol Med Microbiol | year= 2008 | volume= 53 | issue= 3 | pages= 437-9 | pmid=18564289 | doi=10.1111/j.1574-695X.2008.00422.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18564289 }} </ref> | *[[Respiratory distress]] may be present in [[congenital asplenia]] with [[visceral heterotaxy]] with [[bilateral]] [[right-sidedness]]. <ref name="pmid18564289">{{cite journal| author=Thiruppathy K, Privitera A, Jain K, Gupta S| title=Congenital asplenia and group B streptococcus sepsis in the adult: case report and review of the literature. | journal=FEMS Immunol Med Microbiol | year= 2008 | volume= 53 | issue= 3 | pages= 437-9 | pmid=18564289 | doi=10.1111/j.1574-695X.2008.00422.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18564289 }} </ref> | ||
===Heart=== | ===Heart=== | ||
Cardiovascular examination of patients with [[asplenia]] is usually normal. In Right-sided isomerism or Heterotaxy syndromes with complex cardiac anomalies, it revealed:<ref name="pmid22470785">{{cite journal| author=Agarwal H, Mittal SK, Kulkarni CD, Verma AK, Srivastava SK| title=Right isomerism with complex cardiac anomalies presenting with dysphagia--a case report. | journal=J Radiol Case Rep | year= 2011 | volume= 5 | issue= 4 | pages= 1-9 | pmid=22470785 | doi=10.3941/jrcr.v5i4.702 | pmc=3303439 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22470785 }} </ref> | |||
*[[Pre-cordial bulge]] | |||
*[[Right sided apex beat]] | |||
*[[Right sided cardiac dullness]] | |||
*[[ | *[[Pan-systolic murmur]] in right 3–5 [[intercostal space]] | ||
*[[ | *[[Ejection systolic murmur]] in right [[second intercostals space]] | ||
*[[ | |||
*[[ | |||
*[[ | |||
===Abdomen=== | ===Abdomen=== | ||
* Abdominal examination of patients with [ | * Abdominal examination of patients with [asplenia] with sepsis is usually:<ref name="pmid31703560">{{cite journal| author=Albrecht T, Poss K, Issaranggoon Na Ayuthaya S, Triden L, Schleiss KL, Schleiss MR| title=Case report of congenital asplenia presenting with Haemophilus influenzae type a (Hia) sepsis: an emerging pediatric infection in Minnesota. | journal=BMC Infect Dis | year= 2019 | volume= 19 | issue= 1 | pages= 947 | pmid=31703560 | doi=10.1186/s12879-019-4572-4 | pmc=6842177 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31703560 }} </ref> | ||
*Diffuse [[Abdominal tenderness]] | |||
=== | |||
== | |||
* | |||
==References== | ==References== | ||
Latest revision as of 14:29, 20 July 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kalpana Giri, MBBS[2]
Overview
physical findings depend on the associated anomalies. Patients with sickle cell disease, especially children may have enlarged spleen. Physical exam features typically include Cyanosis, Cold extremities, Stiff neck, Breathlessness, Pan-systolic murmur, Pre-cordial bulge, Ejection systolic murmur, Right sided apex beat, Abdominal tenderness.
Physical Examination
Physical examination of patients with asplenia is:
- During the physical examination, the spleen is usually not palpable except in individuals with thin abdominal musculature, hence lack of a palpable spleen does not confirm asplenia.[1]
- Patients with sickle cell disease, especially children in their earlier years, may have enlarged nonfunctional spleen.[2]
- In the case of visceral heterotaxy, a right-sided liver may be mistaken for splenic enlargement.
- Other physical findings depend on the associated anomalies.
- In isolated congenital asplenia, for diagnosis, there are no other physical clues and overwhelming infection may be the first sign of the disease.[3]
- In patient with sepis physical exam was notable for lethargy, irritable, dry mucous membrane.[4]
Vital Signs
- Patients with asplenia usually appear normal. The following variations can be seen in Asplenia infected by invasive bacterial infection. The following signs can be noticed in patients with asplenia infected by invasive bacterial infection.[4]
- Fever
- Tachycardia with regular pulse
- Tachypnea
- Hypotention
Skin
- Cyanosis may be present in congenital asplenia with visceral heterotaxy with bilateral right-sidedness.[2]
- Cold extremities in sepsis. [3]
Neck
- Neck examination of patients with asplenia is usually normal. In Right-sided isomerism or Heterotaxy syndromes with complex cardiac anomalies, dysphagia may be present.[5]
- Stiff neck in fulminant pneumococcal meningitis.[3]
Lungs
- Respiratory distress may be present in congenital asplenia with visceral heterotaxy with bilateral right-sidedness. [2]
Heart
Cardiovascular examination of patients with asplenia is usually normal. In Right-sided isomerism or Heterotaxy syndromes with complex cardiac anomalies, it revealed:[5]
- Pre-cordial bulge
- Right sided apex beat
- Right sided cardiac dullness
- Pan-systolic murmur in right 3–5 intercostal space
- Ejection systolic murmur in right second intercostals space
Abdomen
- Abdominal examination of patients with [asplenia] with sepsis is usually:[4]
- Diffuse Abdominal tenderness
References
- ↑ Erdem SB, Genel F, Erdur B, Ozbek E, Gulez N, Mese T (2015). "Asplenia in children with congenital heart disease as a cause of poor outcome". Cent Eur J Immunol. 40 (2): 266–9. doi:10.5114/ceji.2015.52841. PMC 4637402. PMID 26557043.
- ↑ 2.0 2.1 2.2 Thiruppathy K, Privitera A, Jain K, Gupta S (2008). "Congenital asplenia and group B streptococcus sepsis in the adult: case report and review of the literature". FEMS Immunol Med Microbiol. 53 (3): 437–9. doi:10.1111/j.1574-695X.2008.00422.x. PMID 18564289.
- ↑ 3.0 3.1 3.2 Iijima S (2017). "Sporadic isolated congenital asplenia with fulminant pneumococcal meningitis: a case report and updated literature review". BMC Infect Dis. 17 (1): 777. doi:10.1186/s12879-017-2896-5. PMC 5735542. PMID 29254492.
- ↑ 4.0 4.1 4.2 Albrecht T, Poss K, Issaranggoon Na Ayuthaya S, Triden L, Schleiss KL, Schleiss MR (2019). "Case report of congenital asplenia presenting with Haemophilus influenzae type a (Hia) sepsis: an emerging pediatric infection in Minnesota". BMC Infect Dis. 19 (1): 947. doi:10.1186/s12879-019-4572-4. PMC 6842177 Check
|pmc=value (help). PMID 31703560. - ↑ 5.0 5.1 Agarwal H, Mittal SK, Kulkarni CD, Verma AK, Srivastava SK (2011). "Right isomerism with complex cardiac anomalies presenting with dysphagia--a case report". J Radiol Case Rep. 5 (4): 1–9. doi:10.3941/jrcr.v5i4.702. PMC 3303439. PMID 22470785.