Disease: Enlarged Spleen (Splenomegaly)

What is the spleen, and what is its function?

The spleen is an important organ in the body that has a variety of responsibilities.

  • It is a major filter of blood, helping remove old and damaged red blood cells, and bacteria.
  • It also part of the lymphatic system and produces lymphocytes, a type of white blood cell that is part of the immune system that helps prevent and fight infection.
  • The spleen also acts as a reservoir for red blood cells and platelets, should the body need them.

What does the spleen look like, and where is it located in the body?

The spleen is located in the left upper quadrant of the abdomen, just beneath the diaphragm and next to the stomach. It has a very rich blood supply since it is responsible for filtering blood, and it is protected by the 9th, 10th, and 11th ribs. Normally, it is the size of an orange or a small fist.

The spleen has two types of tissue; the red pulp is responsible for filtering blood, while the white pulp is responsible for its immune function.

Picture of the spleen

What are the causes of an enlarged spleen?

The spleen will enlarge when it performs more of its duties to filter blood or to manufacture blood cells. Therefore, any disease or condition that damages red blood cells, and requires them to be filtered and removed from the blood stream, will cause the spleen to become larger.

Blood disorders

Conditions such as hemolytic anemia, where red blood cells are damaged and broken down (hemolyzed) can cause the spleen to enlarge. Misshapen red blood cells, like those produced in sickle cell anemia, thalassemia, and spherocytosis; may not be able to maneuver through small capillary blood vessels and then become damaged. The damaged cells need to be culled and filtered by the spleen.

Decreased blood flow

The spleen will enlarge if there is a decrease in blood flow through the splenic vein. This may cause spleen congestion and enlargement. This situation may be associated with liver disease and portal hypertension. Damage to liver cells makes it difficult for blood to flow normally, and as blood backs up in the portal vein system, it may also affect pressure in the splenic vein. This increased pressure decreases blood draining from the spleen and causes it to become congested and larger. People with congestive heart failure may have an enlarged liver and spleen because of poor blood flow to and from the heart.

Cancer

Leukemia and lymphoma may be associated with abnormal white cells that can invade the spleen and increase its size.

Metabolic diseases

Certain metabolic diseases may cause the spleen to enlarge, including Hurler Syndrome, Gaucher Disease and Niemann-Pick Disease.

Infection

Some viral infections may cause splenomegaly including:

  • Infectious mononucleosis caused by the Epstein-Barr virus
  • Cytomegalovirus
  • HIV/AIDS
  • Viral hepatitis
  • Malaria
  • Tuberculosis
  • Anaplasmosis

What type of pain, and where is the pain located with an enlarged spleen?

An enlarged spleen, by itself, usually does not cause any symptoms. Because of its location, should it enlarge, the spleen can irritate the diaphragm and cause hiccups and perhaps some pain in the left upper quadrant of the abdomen. It may also compress the stomach, causing the person to feel full after eating a small amount, and therefore unable to eat large meals.

What are other signs and symptoms of an enlarged spleen?

Often, it is not the splenomegaly itself that causes symptoms, but rather it is the symptoms of the underlying illness that causes splenomegaly. Individuals may develop weakness, fatigue and shortness of breath due to anemia (low red blood cell count). Bleeding may be due to thrombocytopenia (low platelet count). Infections may be more prevalent because of ineffective white blood cell function.

How is the diagnosis of an enlarged spleen made?

An enlarged spleen is most often found on physical examination. Either the health care practitioner is looking for an enlarged spleen because of a diagnosis that has already been made, or it is found incidentally when initially examining a patient (and it then serves as a clue to an underlying diagnosis).

With its location protected, beneath the left lower ribs, a normal spleen is usually not felt on physical exam, except in some unusually thin patients. As it enlarges, the spleen grows from the left upper quadrant of the abdomen towards the umbilicus (the belly button). Sometimes the doctor will ask the patient to roll on their right side to better attempt to feel the spleen. An enlarged spleen may not be able to be felt in obese patients.

On occasion, an enlarged spleen may be diagnosed by plain X-ray, ultrasound, abdominal CT scan, or MRI (magnetic resonance imaging).

What is the treatment for an enlarged spleen?

Because splenomegaly is due to another underlying illness, treatment will depend upon the primary cause. In some situations, removal of the spleen (splenectomy) may be part of the treatment. For example, in hereditary spherocytosis, misshapen red blood cells are filtered from the blood stream causing anemia and an enlarged spleen. Splenectomy limits the number of red blood cells destroyed and helps treat the disease.

What complications are associated with an enlarged spleen?

Perhaps the most important worry with an enlarged spleen is the risk of injury as it grows beyond the protection of the rib cage. A minor injury may cause it to fracture and bleed. Spleen injuries are often treated by observation, but on occasion, the spleen can rupture causing life-threatening internal bleeding.

All types of blood cells may become trapped in a large spleen. Anemia (low red blood cell count) may cause weakness, fatigue, dizziness, shortness of breath, and chest pain. Thrombocytopenia (low platelet count) may be associated with an increased risk of bleeding. Leukopenia (low white blood cell count) may be associated with an increased risk of infection.

Should the spleen need to be removed, the risk of certain infections increases, and the patient who undergoes splenectomy will need to make certain that their immunizations are up to date, especially against pneumococcus, meningococcus and haemophilus influenzae.

What are the causes of an enlarged spleen?

The spleen will enlarge when it performs more of its duties to filter blood or to manufacture blood cells. Therefore, any disease or condition that damages red blood cells, and requires them to be filtered and removed from the blood stream, will cause the spleen to become larger.

Blood disorders

Conditions such as hemolytic anemia, where red blood cells are damaged and broken down (hemolyzed) can cause the spleen to enlarge. Misshapen red blood cells, like those produced in sickle cell anemia, thalassemia, and spherocytosis; may not be able to maneuver through small capillary blood vessels and then become damaged. The damaged cells need to be culled and filtered by the spleen.

Decreased blood flow

The spleen will enlarge if there is a decrease in blood flow through the splenic vein. This may cause spleen congestion and enlargement. This situation may be associated with liver disease and portal hypertension. Damage to liver cells makes it difficult for blood to flow normally, and as blood backs up in the portal vein system, it may also affect pressure in the splenic vein. This increased pressure decreases blood draining from the spleen and causes it to become congested and larger. People with congestive heart failure may have an enlarged liver and spleen because of poor blood flow to and from the heart.

Cancer

Leukemia and lymphoma may be associated with abnormal white cells that can invade the spleen and increase its size.

Metabolic diseases

Certain metabolic diseases may cause the spleen to enlarge, including Hurler Syndrome, Gaucher Disease and Niemann-Pick Disease.

Infection

Some viral infections may cause splenomegaly including:

  • Infectious mononucleosis caused by the Epstein-Barr virus
  • Cytomegalovirus
  • HIV/AIDS
  • Viral hepatitis
  • Malaria
  • Tuberculosis
  • Anaplasmosis

What type of pain, and where is the pain located with an enlarged spleen?

An enlarged spleen, by itself, usually does not cause any symptoms. Because of its location, should it enlarge, the spleen can irritate the diaphragm and cause hiccups and perhaps some pain in the left upper quadrant of the abdomen. It may also compress the stomach, causing the person to feel full after eating a small amount, and therefore unable to eat large meals.

What are other signs and symptoms of an enlarged spleen?

Often, it is not the splenomegaly itself that causes symptoms, but rather it is the symptoms of the underlying illness that causes splenomegaly. Individuals may develop weakness, fatigue and shortness of breath due to anemia (low red blood cell count). Bleeding may be due to thrombocytopenia (low platelet count). Infections may be more prevalent because of ineffective white blood cell function.

How is the diagnosis of an enlarged spleen made?

An enlarged spleen is most often found on physical examination. Either the health care practitioner is looking for an enlarged spleen because of a diagnosis that has already been made, or it is found incidentally when initially examining a patient (and it then serves as a clue to an underlying diagnosis).

With its location protected, beneath the left lower ribs, a normal spleen is usually not felt on physical exam, except in some unusually thin patients. As it enlarges, the spleen grows from the left upper quadrant of the abdomen towards the umbilicus (the belly button). Sometimes the doctor will ask the patient to roll on their right side to better attempt to feel the spleen. An enlarged spleen may not be able to be felt in obese patients.

On occasion, an enlarged spleen may be diagnosed by plain X-ray, ultrasound, abdominal CT scan, or MRI (magnetic resonance imaging).

What is the treatment for an enlarged spleen?

Because splenomegaly is due to another underlying illness, treatment will depend upon the primary cause. In some situations, removal of the spleen (splenectomy) may be part of the treatment. For example, in hereditary spherocytosis, misshapen red blood cells are filtered from the blood stream causing anemia and an enlarged spleen. Splenectomy limits the number of red blood cells destroyed and helps treat the disease.

What complications are associated with an enlarged spleen?

Perhaps the most important worry with an enlarged spleen is the risk of injury as it grows beyond the protection of the rib cage. A minor injury may cause it to fracture and bleed. Spleen injuries are often treated by observation, but on occasion, the spleen can rupture causing life-threatening internal bleeding.

All types of blood cells may become trapped in a large spleen. Anemia (low red blood cell count) may cause weakness, fatigue, dizziness, shortness of breath, and chest pain. Thrombocytopenia (low platelet count) may be associated with an increased risk of bleeding. Leukopenia (low white blood cell count) may be associated with an increased risk of infection.

Should the spleen need to be removed, the risk of certain infections increases, and the patient who undergoes splenectomy will need to make certain that their immunizations are up to date, especially against pneumococcus, meningococcus and haemophilus influenzae.

Source: http://www.rxlist.com

Because splenomegaly is due to another underlying illness, treatment will depend upon the primary cause. In some situations, removal of the spleen (splenectomy) may be part of the treatment. For example, in hereditary spherocytosis, misshapen red blood cells are filtered from the blood stream causing anemia and an enlarged spleen. Splenectomy limits the number of red blood cells destroyed and helps treat the disease.

Source: http://www.rxlist.com

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