Enlarged
spleen (splenomegaly)
Overview
Your spleen is an organ that sits just below
your left rib cage. Many conditions — including infections, liver disease and
some cancers — can cause an enlarged spleen. An enlarged spleen is also known
as splenomegaly (spleh-no-MEG-uh-lee).
An enlarged spleen usually doesn't cause
symptoms. It's often discovered during a routine physical exam. A doctor
usually can't feel the spleen in an adult unless it's enlarged. Imaging and
blood tests can help identify the cause of an enlarged spleen.
Treatment for an enlarged spleen depends on
what's causing it. Surgery to remove an enlarged spleen usually isn't needed,
but sometimes it's recommended.
Symptoms
An enlarged spleen typically causes no signs
or symptoms, but sometimes it causes:
·
Pain or fullness in
the left upper belly that can spread to the left shoulder
·
A feeling of fullness
without eating or after eating a small amount because the spleen is pressing on
your stomach
·
Low red blood cells
(anemia)
·
Frequent infections
·
Bleeding easily
When to see a doctor
See your doctor promptly if you have pain in
your left upper belly, especially if it's severe or the pain gets worse when
you take a deep breath.
Causes
A number of infections and diseases can cause
an enlarged spleen. The enlargement might be temporary, depending on treatment.
Contributing factors include:
·
Viral infections, such
as mononucleosis
·
Bacterial infections,
such as syphilis or an infection of your heart's inner lining (endocarditis)
·
Parasitic infections,
such as malaria
·
Cirrhosis and other
diseases affecting the liver
·
Various types of
hemolytic anemia — a condition characterized by early destruction of red blood
cells
·
Blood cancers, such as
leukemia and myeloproliferative neoplasms, and lymphomas, such as Hodgkin's
disease
·
Metabolic disorders,
such as Gaucher disease and Niemann-Pick disease
·
Pressure on the veins
in the spleen or liver or a blood clot in these veins
·
Autoimmune conditions,
such as lupus or sarcoidosis
How the spleen works
Your spleen is tucked below your rib cage next
to your stomach on the left side of your belly. Its size generally relates to
your height, weight and sex.
This soft, spongy organ performs several
critical jobs, such as:
·
Filtering out and
destroying old, damaged blood cells
·
Preventing infection
by producing white blood cells (lymphocytes) and acting as a first line of
defense against disease-causing organisms
·
Storing red blood
cells and platelets, which help your blood clot
An enlarged spleen affects each of these jobs.
When it's enlarged, your spleen may not function as usual.
Risk factors
Anyone can develop an enlarged spleen at any
age, but certain groups are at higher risk, including:
·
Children and young
adults with infections, such as mononucleosis
·
People who have
Gaucher disease, Niemann-Pick disease, and several other inherited metabolic
disorders affecting the liver and spleen
·
People who live in or
travel to areas where malaria is common
Complications
Potential complications of an enlarged spleen are:
·
Infection. An enlarged spleen can reduce the number
of healthy red blood cells, platelets and white cells in your bloodstream,
leading to more frequent infections. Anemia and increased bleeding also are
possible.
·
Ruptured
spleen. Even healthy
spleens are soft and easily damaged, especially in car crashes. The possibility
of rupture is much greater when your spleen is enlarged. A ruptured spleen can
cause life-threatening bleeding in your belly.
Diagnosis
An enlarged spleen is usually detected during
a physical exam. Your doctor can often feel it by gently examining your left
upper belly. However, in some people — especially those who are slender — a
healthy, normal-sized spleen can sometimes be felt during an exam.
Your doctor might order these tests to confirm
the diagnosis of an enlarged spleen:
·
Blood
tests, such as a
complete blood count to check the number of red blood cells, white blood cells
and platelets in your system and liver function
·
Ultrasound
or CT scan to help
determine the size of your spleen and whether it's crowding other organs
·
MRI to trace blood flow through the spleen
Finding the cause
Sometimes more testing is needed to find the
cause of an enlarged spleen, including a bone marrow biopsy exam.
A sample of solid bone marrow may be removed
in a procedure called a bone marrow biopsy. Or you might have a bone marrow
aspiration, which removes the liquid portion of your marrow. Both procedures
might be done at the same time.
Liquid and solid bone marrow samples are
usually taken from the pelvis. A needle is inserted into the bone through an
incision. You'll receive either a general or a local anesthetic before the test
to ease discomfort.
A needle biopsy of the spleen is rare because
of the risk of bleeding.
Your doctor might recommend surgery to remove
your spleen (splenectomy) for diagnostic purposes when there's no identifiable
cause for the enlargement. More often, the spleen is removed as treatment.
After surgery to remove it, the spleen is examined under a microscope to check
for possible lymphoma of the spleen.
Treatment
Treatment for an enlarged spleen focuses on
the what's causing it. For example, if you have a bacterial infection,
treatment will include antibiotics.
Watchful waiting
If you have an enlarged spleen but don't have symptoms
and the cause can't be found, your doctor might suggest watchful waiting. You
see your doctor for reevaluation in 6 to 12 months or sooner if you develop
symptoms.
Spleen removal surgery
If an enlarged spleen causes serious
complications or the cause can't be identified or treated, surgery to remove
your spleen (splenectomy) might be an option. In chronic or critical cases,
surgery might offer the best hope for recovery.
Elective spleen removal requires careful
consideration. You can live an active life without a spleen, but you're more
likely to get serious or even life-threatening infections after spleen removal.
Reducing infection
risk after surgery
After spleen removal, certain steps can help
reduce your risk of infection, including:
·
A series of
vaccinations before and after the splenectomy. These include the pneumococcal
(Pneumovax 23), meningococcal and haemophilus influenzae type b (Hib) vaccines,
which protect against pneumonia, meningitis and infections of the blood, bones
and joints. You'll also need the pneumococcal vaccine every five years after
surgery.
·
Taking penicillin or
other antibiotics after your surgery and anytime you or your doctor suspects
the possibility of an infection.
·
Calling your doctor at
the first sign of a fever, which could indicate an infection.
·
Avoiding travel to
parts of the world where certain diseases, such as malaria, are common.
Lifestyle and home
remedies
Avoid contact sports — such as soccer,
football and hockey — and limit other activities as recommended to reduce the
risk of a ruptured spleen.
It's also important to wear a seat belt. If
you're in a car accident, a seat belt can help protect your spleen.
Finally, be sure to keep your vaccinations up
to date because your risk of infection is increased. That means at least an
annual flu shot, and a tetanus, diphtheria and pertussis booster every 10
years. Ask your doctor if you need other vaccines.
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