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SPLENOMEGALY  By Dr Bashir Ahmed Dar Associate Professor Medicine Chinkipora Sopore Kashmir Email  [email_address]
Slight enlargement just palpable (less than 5 cm ) ,[object Object],[object Object],[object Object],[object Object]
Moderate enlargement (to umbilicus) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Marked enlargement (more than 8 cm or below umbilicus) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Infective causes of splenomegaly ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Infective causes of splenomegaly ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Massive  splenomegaly
Rheumatoid arthritis (Felty’s syndrome) ,[object Object],[object Object]
Features of Felty’s  syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Investigations Felty's syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tropical Splenomegaly ,[object Object],[object Object],[object Object],[object Object]
Tropical Splenomegaly ,[object Object],[object Object],[object Object],[object Object]
Kala azar (leishmaniasis) ,[object Object],[object Object],[object Object],[object Object]
kala azar, black fever, sandfly disease, Dum-Dum fever and espundia.   SYNONYMS
Protozoan in the family   Trypanosomatidae   In the genus   Leishmania
Estimates All over world except Not found in South-east Asia  350 million people at risk 12 million people infected / year There are 59,000 deaths / year
[object Object],[object Object],[object Object],[object Object],[object Object],Some Facts
LEISHMANIASIS or KALA-AZAR It is the result of the infection with one of the species of protozoa (leishmania).  Conveyed by: Sandflies (Phlebotomus). Visceral Leishmaniasis : L. donovani Mucocutaneous   : L. Braziliensis
 
Have specific reservoirs Leishmania   Parasites
Rodents Sloths
Vectors Phlebotomine Sand Flies
30 to 70 eggs hatch 1 to 2 weeks 4 instars diapauses in 4 th  instar pupal development 5-10 days adults crepuscular and nocturnal 20 to 40 days
Opossum Armadillo
 
[object Object],[object Object],[object Object],[object Object]
Cutaneous  :  L. tropica major   L. tropica minor  New World  :  L. Braziliensis   L. Mexicana Old world
PATHOLOGY ,[object Object],[object Object],[object Object],[object Object],»
Leishmania : an obligate intracellular protozoan parasite  ( 2-6 µm in diameter) parasitophorous vacuoles of macrophages
Promastigotes in Sand Fly gut and in Culture Media (about 15-30 µm by 2-3 µm),
[object Object],Amastigote in macrophage
CLINICAL PICTURE ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Forms of Leishmaniasis  ,[object Object],[object Object],[object Object],[object Object]
Cutaneous form
Wet lesion by  L. major ,[object Object],[object Object],[object Object]
Lymphatic spread of  L. major ,[object Object],[object Object]
Clinical Forms of Leishmaniasis
Simple ‘dry’ lesion by  L. tropica ,[object Object],[object Object],[object Object],[object Object]
Leishmaniasis recidivans ,[object Object],[object Object]
Mucocutaneous lesion by  L. aethiopica ,[object Object]
[object Object],[object Object],Chiclero’s ulcer by  L. mexicana
Lymphatic spread of  L. mexicana ,[object Object],[object Object]
[object Object],[object Object],Early lesion of Espundia
Pharyngeal involvement   ,[object Object],[object Object]
 
PKDL Post Kalazar Dermal Leishmaniasis
 
 
 
 
 
 
Visceral form
 
 
Clinical picture of kala-azar in Kenya ,[object Object],[object Object]
 
Diagnosis ,[object Object],[object Object],[object Object],[object Object]
Iliac crest aspiration of bone marrow ,[object Object]
L. infantum  in macrophage from bone marrow ,[object Object]
Amastigotes in macrophage from skin ,[object Object]
Punch biopsy ,[object Object]
Parasitised macrophage in skin section ,[object Object]
DIAGNOSIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
TREATMENT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment ,[object Object],[object Object]
[object Object],[object Object],[object Object]
Myelofibrosis or myelosclerosis ,[object Object],[object Object],[object Object],[object Object]
GAUCHER’S DISEASE
History ,[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object]
What Is It? ,[object Object],[object Object],[object Object]
TYPE 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TYPE 1 (continued) ,[object Object],[object Object]
TYPE 2 ,[object Object],[object Object],[object Object]
TYPE 2 (continued) ,[object Object],[object Object],[object Object],[object Object]
TYPE 3 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Symptoms ,[object Object],[object Object],[object Object],[object Object]
Symptoms (continued) ,[object Object],[object Object],[object Object]
How Do You Get It? ,[object Object],[object Object],[object Object]
If 2 Carriers Have Children ,[object Object]
Who Has It? ,[object Object],[object Object],[object Object],[object Object]
Prevention ,[object Object],[object Object]
Treatments ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hairy cell leukaemia ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object]
[object Object]
[object Object],[object Object]
Hematologic Disorders Causing Massive Splenomegaly ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Massive Splenomegaly By Dr Bashir Ahmed Dar Chinkipora Sopore Kashmir Associate Professor Medicine