Splenomegaly (spleen enlargement) is a condition that often involves hypersplenism, where overactivity the organ results in excessive removal of red blood cells. The been shaped spleen is an essential organ of the body that controls the immune system. Located under the diaphragm on the upper left quadrant of the abdominal cavity, it works to normally clear away invading organisms (bacteria) in the bloodstream and remove abnormal blood cells.
However, the organ can become enlarged, usually as a response of other medical conditions including infections, blood disorders, elevated splenic blood flow and any condition that invades the spleen. Splenomegaly is not necessarily an abnormal condition and an enlargement in some cases will not necessarily result in abnormal function. An enlarged spleen might occur simply because the organ has been simply over performing.
Normally, the spleen is too small to be palpated or felt through the skin. However, when it becomes enlarged, the organ becomes easier to identify when palpating the abdomen.
- Who Is at Risk for Splenomegaly?
- What Causes an Enlarged Spleen?
- Common Symptoms
- Diagnosing Splenomegaly
- Treating Splenomegaly
Who Is at Risk for Splenomegaly?
Any individual of any age can develop splenomegaly. However, there are specific groups attend have a higher potential of developing the condition based on certain risk factors that include:
- Teenagers, children and toddlers with infections like mononucleosis
- Travelers who have visited areas were malaria is both present and common
- Those who suffer with Niemann-Pick disease, Gaucher's disease or another inherited metabolic disorder that affects the spleen and the liver
While an enlarged spleen is not necessarily a severe problem, it can produce potential complications including:
- Ruptured Spleen – The soft tissue of a healthy spleen can become easily damaged, especially in automobile accidents or other trauma to the abdomen. If the spleen is enlarged, the potential of a rupture is significantly heightened and can produce life-threatening bleeding out of the organ into the abdominal cavity.
- Infection – An overactive spleen reduces the number of healthy platelets, white blood cells and red blood cells by removing them from the bloodstream unnecessarily. This increases the potential of causing frequent infections, increase bleeding and/or anemia.
What Causes an Enlarged Spleen?
In many cases, the large spleen is the result of an overactive organ and not an underlying cause a disease or infection. However, the most common causes of splenomegaly include:
- Mononucleosis and other viral infections
- Endocarditis (infected interlining of the heart), syphilis or other bacterial infection
- Malaria or other parasitic infection
- Myeloproliferative neoplasms, leukemia and other blood cancers including Hodgkin's disease and other lymphomas
- Niemann-Pick disease, Gaucher's disease and other metabolic disorders
- Pressure on veins in the liver or spleen
- Blood clots affecting the spleen or liver
Many individuals with an enlarged point never display or feel any symptoms associated with the condition. However, the most common splenomegaly symptoms for others involve:
- Easy bleeding
- Frequent infections
- A sensation of fullness or pain occurring in the area of the spleen (left upper abdomen) that spreads to the left shoulder
- A sensation of feeling full after consuming small portions of food or without eating
Any individual who experiences pain or extensive discomfort in the left upper abdomen that worsens when deep breathing should consider seeking out immediate medical attention.
Splenomegaly is typically detected during a comprehensive physical examination. The diagnostician can usually palpate (press on) and identify the spleen in the left upper abdomen because it has become enlarged. That said, normal-sized healthy spleen's can sometimes be palpated in slender individuals during an examination.
To confirm the diagnosis of splenomegaly the doctor will typically order tests and procedures that provide verification. These include:
- Complete Blood Count – This blood test can determine the number of white blood cells, platelets, and red blood cells in the bloodstream.
- CT (Computerized Tomography) Scan and Ultrasound Scan – These two scanning procedures can provide visual imagery of the spleen to identify its size, location, and if the condition has crowded other organs in the torso.
- MRI (Magnetic Resonance Imaging) Scan – The scan can trace the flow of blood as it travels through the spleen to identify any blockage caused by an obstruction or pressure from another source.
- Bone Marrow Examination – Examining the makeup of bone marrow can help identify the number of drug blood cells, white blood cells, platelets being produced in the interior of the bones. This examination is performed using a fine needle aspiration technique where liquid samples of bone marrow are removed from the pelvis.
- Liver Functioning Tests – This test can help determine if the spleen is overly active or if the function of the liver is causing the spleen to become enlarged.
- Spleen Biopsy – Though rare, the doctor may recommend a needle biopsy were portion or sample of the spleen is removed for examination under a microscope in a laboratory setting. However, this procedure is rare because of the significant risk of organ bleeding.
Performing imaging tests for visual imagery is not always required to accurately diagnose splenomegaly. To obtain the best results, the patient should refrain from eating prior to the procedure.
The type of treatment the doctor will recommend will likely Bay based on the underlying issues that because the problem initially. If the doctor determines that the splenomegaly condition is the result of a bacterial infection, they will likely recommend an extensive treatment of antibiotic medications to kill off the invading bacteria. Other options for treating and a large spleen include:
- Watchful Waiting – If the doctor verifies a diagnosis of splenomegaly without determining an underlying cause and the patient does not experience any symptoms, it may be recommended to simply weight and watched to see if the condition corrects itself or does not worsen. Typically, the doctor will want to perform a reevaluation and examination within a year or sooner, especially if symptoms begin to develop.
- Spleen Removal – If the patient is experiencing serious complications associated with an enlarged spleen or the underlying cause is not identified or treated, a splenectomy (surgical removal of the spleen) is likely be only option. The best chance for recovery and critical and chronic cases is usually obtained through surgery.
There are associated risks involved in performing surgical operations on the spleen or removing the organ from the body. Because of that, electing to remove the spleen should be carefully considered. That said, many individuals live up healthy and active life after their spleen has been removed, especially if damage was caused by excessive trauma, like a car accident. However, many individuals who have had their spleen removed contract life-threatening or serious infections.
The doctor may choose to use radiation therapy to shrink the enlarged organ as a way of avoiding undergoing the knife and having the spleen removed. The doctor may recommend that the patient follow specific steps at reducing the potential risk of developing infections including undergoing a series of vaccinations to protect against meningitis, pneumonia, and joint/bone/blood infections.
Following an antibiotic regimen of penicillin before and after surgery can diminish the potential of developing an infection. Additionally, individuals should consider the dangers of traveling parts of the world that have malaria.