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Splenomegaly – Symptoms, Causes and Treatment

What is Splenomegaly?

Splenomegaly (Enlarged Spleen) is the term used for an enlarged spleen. The spleen is an orange-shaped organ located just below the left rib cage, surrounded by your 9th, 10th, and 11th ribs. Many conditions, including infections, liver disease, and some cancers, can cause an enlarged spleen. The treatment for an enlarged spleen focuses on the underlying condition causing it.

There are two types of tissues in the spleen – the red pulp tissue and the white pulp tissue. The former filters the blood, and the latter takes care of the immune function.

Functions of the spleen

The spleen is a part of the human lymphatic system, located in the abdomen. It is present behind the left ribs. It is a soft, spongy organ that performs several critical jobs. It usually is about the size of your fist.

Destruction of the old and defective red blood cells is the primary function of the spleen. It also produces WBC- lymphocytes and prevents infections. Besides, it stores RBCs and platelets.

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.

Symptoms of splenomegaly

Usually , splenomegaly causes no symptoms. However, the following symptoms can be to underlying pathology or as a result of a complication:

● You might develop anemia and /or look pale

● You might develop frequent infections.

● You may notice that you bleed easily.

● You might feel discomfort or pain in the upper left part of your belly. Sometimes, this might radiate pain to your left shoulder.

● You may be fatigued.

● You might feel full without eating or after eating only a small amount due to the enlarged spleen pressing on your stomach.

You should see a doctor if you have severe pain in your left upper belly, especially if the pain gets worse when you take a deep breath.

What are the complications that can occur due to splenomegaly?

Splenomegaly can lead to complications like-

● Infection and anemia.

May cause complications like anemia, increased bleeding and frequent infections.

● Ruptured spleen.

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

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

Splenomegaly is not specific to any particular age group. Any individual with the causes mentioned above can increase the risk. Also, people staying in or traveling to malaria-ridden regions are at higher risk of developing splenomegaly.

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.

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.

When to see a doctor?

If you experience sharp pain in the left side of your upper abdomen (part of the lymph system where the spleen sits) that increases with deep breaths, you should seek medical help immediately.

Request an appointment at Apollo Hospitals.
Call 1860-500-1066 to book an appointment.

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

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