Enlarged spleen (splenomegaly)

Enlarged spleen (splenomegaly)

Definition:

Your spleen is a small organ located just below your rib cage on your left side. Normally, your spleen is about the size of a fist, but a number of conditions — from infections to liver disease and some cancers — can cause an enlarged spleen, also known as splenomegaly (spleh-no-MEG-uh-lee).

Most people don't have symptoms with an enlarged spleen. The problem is often discovered during a routine physical exam. Your doctor won't be able to feel a normal-sized spleen — unless you're very slender — but can feel an enlarged spleen.

Treatment for an enlarged spleen focuses on relieving the underlying condition. Although surgically removing an enlarged spleen isn't a first choice, it may be an option for you in certain situations.

Symptoms:

An enlarged spleen may cause:

• No symptoms, in some cases
• Pain or fullness in the left upper abdomen that may spread to the left shoulder
• Feeling full without eating or after eating only a small amount — this can occur when an enlarged spleen presses on your stomach
• Anemia
• Fatigue
• Frequent infections
• Easy bleeding

When to see a doctor
See your doctor promptly if you have pain in your left upper abdomen, especially if it's severe or the pain gets worse when you take a deep breath.


Causes:

A number of infections and diseases can contribute to an enlarged spleen. The effects on your spleen may be only temporary, depending on how well your treatment works. 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 premature destruction of red blood cells
• Blood cancers, such as leukemia, and lymphomas, such as Hodgkin's disease
• Metabolic disorders, such as Gaucher's disease and Niemann-Pick disease
• Pressure on the veins in the spleen or liver or a blood clot in these veins

How the spleen works
Your spleen is tucked under your rib cage next to your stomach on the left side of your abdomen. It's a soft, spongy organ that performs several critical jobs and can be easily damaged. Among other things, your spleen:

• Filters out and destroys old and damaged blood cells
• Plays a key role in preventing infection by producing white blood cells called lymphocytes and acting as a first line of defense against invading pathogens
• Stores red blood cells and platelets, the cells that help your blood clot
• May act as an intermediary between your immune system and your brain, leading researchers to speculate that they may one day be able to trigger the spleen's infection-fighting abilities by manipulating the nervous system

An enlarged spleen affects each of these vital functions. For instance, as your spleen grows larger, it begins to filter normal red blood cells as well as abnormal ones, reducing the number of healthy cells in your bloodstream. It also traps too many platelets. Eventually, excess red blood cells and platelets can clog your spleen, interfering with its normal functioning. An enlarged spleen may even outgrow its own blood supply, which can damage or destroy sections of the organ.


Complications:

Potential complications of an enlarged spleen are:

• Infection. Because an enlarged spleen can reduce the number of healthy red blood cells, platelets and white cells in your bloodstream, you may develop frequent infections. Anemia and increased bleeding also are possible.
  
• Ruptured spleen. Even healthy spleens are soft and easily damaged, especially in car crashes. When your spleen is enlarged, the possibility of rupture is far greater. A ruptured spleen can cause life-threatening bleeding into your abdominal cavity.

Treatments and drugs:

If an enlarged spleen causes serious complications or the underlying problem can't be identified or treated, surgical removal of your spleen (splenectomy) may be an option. In fact, in chronic or critical cases, surgery may offer the best hope for recovery.

But elective spleen removal requires careful consideration. You can live an active life without a spleen, but you're more likely to contract serious or even life-threatening infections, including overwhelming post-splenectomy infection, which can occur soon after the operation. Sometimes, radiation can shrink your spleen so that you can avoid surgery.

Reducing infection risk after surgery
If you do have your spleen removed, certain steps can help reduce your risk of infection, including:

• A series of vaccinations both before and after the splenectomy. These include the pneumococcal (Pneumovax), meningococcal and haemophilus influenzae type b (Hib) vaccines, which protect against pneumonia, meningitis, and infections of the blood, bones and joints.
• Taking penicillin or other antibiotics after your operation and anytime you or your doctor suspects the possibility of an infection.
• Avoiding travel to parts of the world where diseases such as malaria are endemic.