Asplenia physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anum Dilip, M.B.B.S[2]
Overview
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.
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
Back
- Back examination of patients with [disease name] is usually normal.
OR
- Point tenderness over __ vertebrae (e.g. L3-L4)
- Sacral edema
- Costovertebral angle tenderness bilaterally/unilaterally
- Buffalo hump
Genitourinary
- Genitourinary examination of patients with [disease name] is usually normal.
OR
- A pelvic/adnexal mass may be palpated
- Inflamed mucosa
- Clear/(color), foul-smelling/odorless penile/vaginal discharge
Neuromuscular
- Neuromuscular examination of patients with [disease name] is usually normal.
OR
- Patient is usually oriented to persons, place, and time
- Altered mental status
- Glasgow coma scale is ___ / 15
- Clonus may be present
- Hyperreflexia / hyporeflexia / areflexia
- Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
- Muscle rigidity
- Proximal/distal muscle weakness unilaterally/bilaterally
- ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
- Unilateral/bilateral upper/lower extremity weakness
- Unilateral/bilateral sensory loss in the upper/lower extremity
- Positive straight leg raise test
- Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
- Positive/negative Trendelenburg sign
- Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
- Normal finger-to-nose test / Dysmetria
- Absent/present dysdiadochokinesia (palm tapping test)
Extremities
- Extremities examination of patients with [disease name] is usually normal.
OR
- Clubbing
- Cyanosis
- Pitting/non-pitting edema of the upper/lower extremities
- Muscle atrophy
- Fasciculations in the upper/lower extremity
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 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. - ↑ 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.