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The primary care physician may be the first to detect a palpably enlarged spleen and will probably have a major role in determining treatment. Therefore, he or she needs to know the normal functions, weight, and dimensions of the spleen; how to diagnose splenomegaly in an office visit; and when referral is appropriate. The author summarizes the many causes of splenomegaly and the resultant natural history of the condition and outlines the basic diagnostic routine.