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Splenomegaly – Symptoms, Causes and Treatment

Overview

The spleen is a small organ located right behind your left rib cage. An enlarged spleen can be caused by a variety of factors, including infections, liver illness, and various malignancies. Splenomegaly is the medical term for an enlarged spleen.

Your lymphatic system includes your spleen. It aids the immune system by storing white blood cells and assisting in antibody production. This organ is located beneath your rib cage on the left side of your body. It’s in charge of:

Because it produces two types of white blood cells: B cells and T cells, the spleen is critical in your body’s defense against infection. Bacteria and illnesses are fought off by white blood cells. The spleen is generally approximately the size of a fist, but it can grow to be considerably larger if it is enlarged.

What should I look out for?

Some people with an enlarged spleen have no symptoms and are only diagnosed during a normal medical examination. If you’re extremely thin, you might be able to feel your enlarged spleen through your skin. 

A sense of pain or discomfort in the upper left side of the abdomen, where the spleen is located, is a common sign of an enlarged spleen. You may also feel full after only a tiny amount of food has been consumed. This occurs when the spleen enlarges to the point where it presses against the stomach.

If your spleen presses on other organs, blood flow to the spleen may be affected. Your spleen may be unable to filter your blood effectively as a result of this. If your spleen grows too large, it may begin to remove an excessive amount of red blood cells from your blood. Anemia is a disorder that occurs when the body’s red blood cells are insufficient. Infections may become more common if your spleen can’t produce enough white blood cells as a result of its expansion.

When to see a doctor?

It’s critical to schedule an appointment with your doctor if you’re experiencing symptoms of an enlarged spleen. See your doctor as soon as possible if you have significant pain in the upper left side of your abdomen, or if the pain worsens when you breathe.

Impact of Splenomegaly

Splenomegaly disturbs each of the above-mentioned functions. An enlarged spleen starts filtering both abnormal and normal RBCs. This reduces the total cellular volume in your blood, increasing platelet trapping. This can eventually cause a clogging of the spleen with too many blood cells and affect its normal functioning. Sometimes, the size of the spleen increases more than its potential blood supply. This destroys parts of the spleen.

Commonly, splenomegaly is detected during a general physical examination, as it does not cause any symptoms. To identify the underlying cause, doctors usually recommend blood tests and imaging. The treatment mainly focuses on treating the cause . Surgical removal of the spleen is sometimes mandatory.

Splenomegaly can be easily confused with ‘hypersplenism’. The term connotes overactive function by a spleen of any size. This does not necessarily mean that your spleen is enlarged.

What can be the causes of splenomegaly?

Sometimes, the spleen enlarges temporarily and subsides as the cause is treated. Therefore, it is important to know the cause of splenomegaly for treatment:

  • Liver diseases such as liver cirrhosis.
  • Viruses infecting the body, causing diseases like mononucleosis.
  • Certain metabolic disorders like Niemann-Pick disease and Gaucher’s disease.
  • Bacteria causing endocarditis or syphilis.
  • A blood clot decreasing the blood flow to the spleen.
  • Infections caused by parasites like malarial parasites.
  • Predisposing conditions like myeloproliferative neoplasms, leukemia or any lymphomas
  • Hemolytic anemia that destroys the RBCs.

How do you know if you are at greater risk of developing splenomegaly?

At any age, anyone can acquire an enlarged spleen, however certain groups are more vulnerable, including:

  • Infections such as mononucleosis affect children and young adults.
  • People with Gaucher disease, Niemann-Pick disease, and other inherited liver and spleen metabolic diseases
  • People who reside in or travel to malaria-endemic areas

What are the complications that can occur due to splenomegaly?

Splenomegaly can lead to complications like-

It is a very soft organ, making it more susceptible to traumatic damage. The possibility increases in splenomegaly. This can cause fatal internal bleeding.

What is the method of diagnosing splenomegaly?

A routine physical exam of the abdomen usually detects splenomegaly. Usually, the spleen cannot be felt by the doctor on examination, unless you are very thin. There is nothing to worry about if so, as it might still be healthy and normal in size. The lack of abdominal fat makes it more palpable.

Any suspicious findings are backed-up by the following tests:

  • Blood tests: CBC is done as a primary test. A complete blood count gives you the total count of RBCs, WBCs, and platelets in your blood, helping the diagnosis.
  • CT scan and ultrasonography: It can help measure the exact size through advanced imaging. It also reports any pressure on other internal organs.
  • MRI: Magnetic Resonance Imaging is an imaging technique that helps evaluate the blood supply to the spleen.

The other test that may occasionally be required are:

  • Liver function tests (LFT).
  • Bone marrow examination.
  • Bone marrow biopsy &/or bone marrow aspiration.
  • FNAC or fine-needle aspiration cytology is very rarely performed given the chances of bleeding complications.

When the cause cannot be detected, surgical removal is recommended. A pathophysiological examination then follows , which can determine the exact cause of the splenomegaly .

Is there any treatment for splenomegaly?

The treatment is done by treating the cause. In case the cause could not be detected, your doctor will suggest to wait and watch. Follow your doctor’s instructions for any required re-evaluation and follow-up.

Your doctor might recommend splenectomy (surgical removal of the spleen) if any serious complication occurs or if the cause is unknown for a long time. In long-lasting or complicated cases, surgery might have the best prognosis.

Splenectomy usually follows temporary leukocytosis (an increase in the number of white cells in the blood). It is a physiological response to the removal of the spleen. Your doctor might do some tests to rule out postoperative sepsis, a complication of splenectomy.

As splenectomy can cause serious and sometimes life-threatening infections, sometimes, radiation treatment to the spleen can be used to shrink it and relieve the symptoms. This can be an alternative to surgery.

Lifestyle modifications and prevention of complications

The following tips can help you keep your spleen safe:

  • Be up-to-date with your vaccinations
  • Avoid sports that are rough such as football, soccer, and hockey as they can rupture the spleen.
  • Prevent serious trauma to your spleen due to a car accident by wearing a seat belt.

Conclusion

Slight differences in spleen size are frequent and not to be concerned about. However, if you feel your spleen is enlarged or if you’re experiencing any organ-related issues, you should contact a doctor as soon as possible. If an infection is causing this temporary spleen enlargement, it’s best to get it recognized and treated as soon as possible. 

The spleen can be removed in severe cases of spleen malfunction. You’ll be more susceptible to diseases, which means it’ll be even more vital to stay up to date on vaccines and other preventive measures, such as washing your hands carefully and consistently or avoiding persons who may be contagious.

FAQs: Frequently asked questions

What are the symptoms of splenomegaly?

A. Usually presents with no symptoms. However, some symptoms that can be noted are: pain or fullness in the left upper abdomen, feeling full without eating or after eating only a small amount, anemia, fatigue, frequent infections, easy bleeding.

Is splenomegaly painful?

A. Not always, however, pain or fullness in the left upper abdomen that may spread to the left shoulder is not uncommon. If the disease is severe, the pain gets worse when you take a deep breath.

Can splenomegaly be cured?

Depending on the reason for an enlarged spleen, it can be cured or will likely get back to its normal size when the underlying condition heals. In general, in splenomegaly, owing to infectious mononucleosis, the spleen goes back to its normal size as the infection reduces.

What foods should you avoid if you have an enlarged spleen?

If you have an enlarged spleen, you need to avoid the following:

  • Avoid eating food items that are too cold or too raw, as a diet with high water content can lead to cellulite buildup and inflammation.
  • Avoid excessive sugar intake, as it will overwork your pancreas and affect the spleen.
  • Follow a regular eating pattern as erratic eating habits can cause pain to the spleen.

What is the most common cause of splenomegaly?

Some of the common causes of an enlarged spine are:

  • Bacterial (syphilis, endocarditis)
  • Viral infections (mononucleosis)
  • Liver conditions like cirrhosis
  • Parasite-borne diseases like malaria

What is the average size of spleen?

In general, the size of the spleen (a part of the lymph system) in an adult is around 3-inches wide, 5-inches long, and 1.5-inches thick. It weighs about 6 ounces. Men and taller people tend to have larger spleens than women and shorter people, respectively.

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Verified By Dr Salil Parida
MBBS, MS(Gen. Surg.), M.ch(Surg. gastro), SURGICAL GASTROENTEROLOGY Apollo Hospitals, Bhubaneshwar
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