"Mohammad’s Spleen is Palpable"

"Mohammad’s Spleen is Palpable"

1. Anatomy and Palpation of the Spleen

   • spleen is a lymphatic organ located right above the stomach in the left hypochondriac region which corresponds to the ULQ.
   • Spleen Functions:
     • Filters the blood from pathogens and debris
     • Controls the level of blood cells
     • Removes any old or damaged red blood cells.
   • Palpation of the spleen
     • Place your right hand behind the patient's inferior rib cage to support it. Then, use your left hand to palpate along the left costal margin.
   • Causes of Splenomegaly
     • Infections
       • Mononucleosis
     • Diseases affecting the liver
     • Hemolytic anemia
     • Blood cancers
       • How to Differentiate between leukocytosis, leukemia and leukemoid reaction?
         • Leukocytosis
           • Increase total number of WBCs to > 11,000/mm3.
             • Common cause is neutrophilia followed by lymphocytosis.
               • Pathological (tissue damage, infections & worm infestations)
         • Leukemoid reaction & leukemia
           • Leukocytosis >50,000/microL when due to causes other than leukemia
             • Characterized by a significant increase in early neutrophil precursors (myelocytes, metamyelocytes)
               • Leukemia: Uncontrolled production of WBCs mainly caused by cancerous mutation.
                 • Leukemoid reaction
                   • Proliferation of all the normal myeloid elements is observed in the BM
                 • Classification of Leukemias
                   • According to the clinical course of the leukemia.
                   • According to their cell of origin in the hematopoiesis process.
                   • depending on which lineage is affected.
                   • FAB Classification of ALL
                   • What is Chronic Myeloid Leukemia?
                     • About 15% of leukemias in adults are CML
                     • Philadelphia chromosome
                       • Translocation between chromosome 9 and 22.
                         • sometimes found in acute lymphocytic leukemia.
                     • CML Phases
                     • Fatigue, weakness, night sweats
                     • Diagnosis
                       • Complete blood count (CBC)
                       • Bone marrow biopsy
                       • Bone marrow tissue sample
                     • Risk Factors for CML
                       • Age
                       • Gender
                       • Congenital disorders
                       • Chemical & drugs
                     • Pathogenesis of CML
                       • caused by a reciprocal translocation t(9;22),
                       • a piece of chromosome 9 containing the ABL1 oncogene is translocated to chromosome 22 and fused to the BCR gene
                         • BCR-ABL fusion gene to take place and for tyrosine kinase activity to become irregular.
                     • Investigations of CML
                       • CBC
                       • blood smear
                       • Bone marrow biopsy
                         • Hypercellularity - cells of myeloid cell line precursors
                       • Karyotypic analysis
                       • Fluorescent in situ hybridization FISH
                       • PCR: BCR-ABL-1 gene mapping
                     • Treatment of CML
                       • Imatnib (first line treatment)
                       • Stem cell transplant
                       • Splenectomy
                       • Other treatments
                       • Treatment Complications
                     • Epidemiology
                       • Leukemia
                         • Males > females
                         • ALL ( 80%) > AML (20%) in children
                         • CLL affects adults > 65 years
                         • CML is rare in children
                         • Coping mechanisms
                           • Self Compassion
                           • Achieve Balance
                           • Managing thoughts
                           • Financial coping :
                             • Dh300,000 to Dh400,000
                             • Local charities
                       • CML

2. Impact of the Internet on the Patient’s Understanding

   • survey of 240 family physicians
   • Most have observed patients seeking out “Dr. Google” at increasing rates
   • 97% percent of physicians said their patients are coming into the office with incorrect information.

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