Splenomegaly in Childhood

Yıl 2013, Cilt: 1 Sayı: 1, 10 - 16, 01.04.2013

Nafia Kazancı Samet Ozer Resul Yılmaz Erhan Karaaslan

Öz

Splenomegaly in childhood is generally first suspected upon physical examination.Spleen is palpable in %15 of neonates and %10 of normal children.The normal spleen is less than 1-2 cm below the left costal margin.An anlarged spleen is often firm and may have abnormal surface. The etiology of splenomegaly varies with age and differential diagnoses of splenomegaly is extensive but careful history taking and physical examination, along with a CBC count and liver function tests, often help in narrowing the list of differential diagnoses Malaria, schistosomiasis, and other infections in endemic areas are frequent causes of splenomegaly and Splenic rupture may occur in acute splenomegaly associated with infectiousmononucleosis. The goal of treatment is to treat the underlying disease but splenectomy is uncommonly performed in children with splenomegaly and postsplenectomysepsis is the most important mortal complication. Benefits must be carefully weighed when splenectomy is being considered. The new PCV7 conjugated pneumococcal vaccine and the older PPV23 polyvalent pneumococcal vaccines and the Haemophilus influenzae vaccine should be administered to all children who are asplenic and to those about to undergo splenectomy.

Anahtar Kelimeler

children, splenomegaly, spleen enlargement

Çocukluk Çağında Splenomegali

Öz

Çocukluk çağında splenomegali genellikle ilk olarak fizik muayenede tespit edilir. Dalak yenidoğanların %15’inde ve sağlıklı çocukların ise %10’unda kosta altında 1-2 cm ele gelir. Patolojik olarak büyümüş dalak genellikle sert ve düzensiz yüzeylidir. Splenomegali etyolojisinin yaş ile değişmesine ve ayırıcı tanısının çok geniş kapsamlı olmasına rağmen dikkatli öykü alınması, fizik muayene, tam kan sayımı ve karaciğer fonksiyon testleri genellikle ayırıcı tanı listesini oldukça kısaltır. Malarya ve Şistozomiyazis endemik bölgelerde splenomegalinin sık görülen nedenleridir. İnfeksiyöz mononükleozise bağlı akut splenomegalide splenik rüptür gelişebilir. Splenomegalide tedavinin amacı öncelikle altta yatan nedeni tedavi etmektir ancak splenektomi bazı olgularda nadiren de olsa uygulanır. Bu hastalarda postsplenektomi sepsisi en önemli ölümcül koplikasyondur bu nedenle splenektomi kararından önce faydaları dikkatlice gözden geçirilmelidir. Asplenik ya da splenektomi yapılması planlanan tüm çocuklara konjuge pnömokok, polivalan pnömokok ve Hemofilus İnfluenza aşıları yapılmalıdır

Anahtar Kelimeler

çocuk, splenomegali, dalak büyümesi

Kaynakça

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