Enlarged Spleen

1 What Is Enlarged Spleen?

An enlarged spleen is often a feature of conditions like infections, liver disease, blood disorders, cancers, trauma, and others. The spleen is an organ located under the ribs, and it functions as a filter and storage space for blood and white blood cells. It is also the place where old or damaged red blood cells are destroyed. An enlarged spleen is a condition called “splenomegaly.” It is a clear warning sign that the immune system is fighting hard to remove threats from the body, but is unable to do so since it cannot keep up with the high demand.

Enlarged spleen often does not cause symptoms, but doctors can palpate it during a routine physical examination.

If you have an enlarged spleen, the doctor will request lab tests and imaging to determine the underlying cause.

Enlarged spleen always has a cause, and it does not happen alone, so treatment is focused on addressing the underlying condition. Sometimes, treatment involves removal of the spleen, but this is not always the case.

The spleen is situated at the left side of the stomach. Depending on the person, the size and shape of the spleen varies. But, in general, it is fist-shaped, about four inches long, and purple in color. One cannot feel it, since it is protected by the rib cage. The spleen can only be felt if it becomes abnormally enlarged. The spleen is an integral organ which plays various roles to support the body with its day-to-day functioning. It acts as a filter for blood as part of the immune system. Old red blood cells get recycled in the spleen, and white blood cells and platelets are stored there. The spleen is also known to fight against certain bacteria which cause pneumonia or meningitis.

The spleen can experience a number of conditions, such as:

  • Sickle cell disease: This disease is an inherited form of anemia which involves abnormal red blood cells. These red blood cells block the flow of blood, thus leading to organ damage, including the spleen. People suffering from sickle cell disease need immunizations to prevent illnesses which their spleen helped to fight off.
  • Enlarged spleen: Viral mononucleosis, or mono, blood cancers such as leukemia or lymphoma, and liver disease are all known to cause an enlarged spleen.
  • Ruptured spleen: The spleen is very vulnerable to injury. A spleen which has ruptured is known to cause internal bleeding, which can turn life-threatening if not treated on time. After an injury, the spleen can rupture immediately, or it may take days or weeks to rupture.
  • Accessory spleen: Accessory spleen is a condition where people have a small, extra spleen. This happens in about ten percent of cases and is quite normal and does not cause any trouble.
  • Thrombocytopenia: Enlarged spleen, in a few instances, may store excessive numbers of platelets. An abnormally low number of platelets circulating in the bloodstream can result in splenomegaly.

2 Symptoms

An enlarged spleen does not always produce signs or symptoms. If they do, they may appear as:

  • A feeling of fullness or pain in the upper left abdomen, which may radiate to the left shoulder
  • Feeling full even without eating
  • Frequent illnesses or infections
  • Anemia
  • Unexplained fatigue
  • Bruising or bleeding easily
  • An uncomfortable feeling while eating, or indigestion, usually after having a large meal
  • Tenderness or pain around the spleen area
  • Pain while taking deep breaths or even while moving around
  • Chronic fatigue, or energy levels dipping down without doing much physical activity
  • Jaundice and yellowing of the skin
  • Frequent infections, such as urinary tract infections, ear infections, or sinus infections
  • Loss of appetite or sudden weight loss

One of the common side effects of a damaged spleen is fatigue. This happens because the spleen works as part of the body’s natural “drainage network.” It produces protective white blood cells and then carries out waste and bacteria away from the body. The role of the spleen is to produce white blood cells, which capture and destroy bacteria, dead tissues, and cells or any other outside particles that make their way into the bloodstream and circulate in the blood, leading to infection. If the spleen is not maintained properly, the body cannot maintain red and white blood cells, which is very important for ongoing energy and proper platelet production, which are required for blood clotting.

3 Causes

The spleen plays several roles in the body, therefore, its enlargement can be caused by many things, such as:

  • Bacterial or viral infections from diseases like mononucleosis, syphilis, endocarditis, and many others
  • Certain parasitic diseases like malaria
  • Liver problems like cirrhosis
  • Blockage or increased blood pressure in the veins supplying the spleen or liver
  • Hemolytic anemia, or anemia caused by an abnormally high rate of destruction of red blood cells
  • Cancers that affect the blood like leukemia and lymphomas like Hodgkin’s disease
  • Gaucher’s disease, Niemann-Pick disease, or other metabolic diseases

The spleen sits under the rib cage, next to the stomach, so it causes a feeling of fullness when it swells. The spleen is involved in filtering the blood, destroying old, worn-out red blood cells, storing red blood cells and platelets, and producing white blood cells needed to fight infections. Any condition or disease that affects these functions can cause the spleen to enlarge.

Enlarged spleen itself causes more problems. An enlarged spleen contains lots of blood and thus is susceptible to rupture, which can result in massive internal bleeding.

An enlarged spleen may begin to filter out normal components of the blood (red and white cells and platelets) along with unhealthy ones, causing profound anemia and bleeding tendencies due to a deficiency in platelets. The spaces inside the spleen clog up and cause problems in functioning. In some cases, the enlarged spleen can grow so large that it outgrows its oxygen supply, causing damage and destruction.

4 Making a Diagnosis

Most cases of enlarged spleen are diagnosed during physical exams, often when patients seek a doctor for other health ailments. Doctors can easily palpate the enlarged spleen, which may manifest as a mass in the upper left abdomen. The doctor will usually press the belly under the ribcage on the left side. By doing so, they can feel if the spleen is enlarged or not.

If the physical exam indicates an enlarged spleen, the doctor may order the following imaging tests:

  • Blood tests to check the number of red blood cells, white blood cells, and platelets
  • Magnetic resonance imaging (MRI) to check the organs in the abdomen, including the spleen and liver, for swelling and to trace blood flow in the spleen. Highly detailed images of the abdomen are created by magnetic waves.
  • Ultrasound or CT scan to check the size of the spleen and see if it is crowding out other organs. With an ultrasound, a probe is placed on the belly. Harmless sound waves are produced, which create images by reflecting the spleen and other organs. With a CT, or computed tomography, scan, the scanner takes multiple X-rays. A computer then creates detailed images of the abdomen. If the images are not clear, a contrast dye may be injected into the veins to improve clarity.

These imaging procedures require little or no preparation, except for the CT scan. For a CT scan, you might have to avoid eating before the test. Your doctor will tell you the preparations needed for each test.

Sometimes, doctors may order more tests to determine any underlying causes of an enlarged spleen. If you have other symptoms, or if the imaging tests show other problems, the doctor may order liver function tests or bone marrow exams. Liver function tests are used to check liver health. A bone marrow exam checks bone marrow for any signs of cancer. Liquid bone marrow is obtained by aspirating it from a bone using a long, big-bore syringe, while solid bone is obtained by extracting it from the hip bone through surgery.

The tissues in the spleen can be obtained through a needle biopsy, wherein a long needle is inserted into the abdomen until it reaches the spleen and the contents are aspirated. However, this procedure carries the risk of bleeding, which is a concern with enlarged spleen and a platelet deficiency.
Some cases of enlarged spleen have no causes. In such instances, the doctor may recommend having the spleen removed through major surgery. The removed spleen is then examined under a microscope to determine the cause of the enlarged spleen, such as cancer.

5 Treatment

Treatment for enlarged spleen involves addressing the underlying cause. If it is a bacterial infection, the doctor may administer antibiotics, or antimalarial medications in case of malaria.

Some cases of enlarged spleen don’t have symptoms, and tests are unable to determine the cause. In this case, the doctor may recommend watchful waiting. You will have to undergo regular check-ups for six months to a year, or sooner if you develop symptoms.

If the chronic, or enlarged, spleen causes serious complications, the doctor may recommend a splenectomy, or total removal of the spleen. Surgery may be the best option if the spleen causes life-threatening complications. There is also another procedure wherein radiation is directed at the spleen to shrink it, eliminating the need for surgery.

The spleen is not a vital organ in the body, and most people can live an active life without it. The side effect of spleen removal, however, is an increased susceptibility to infections.

Here are things you can do to reduce the likelihood of infections after a splenectomy:

  • Avoid travel to areas with high rates of malaria and other infectious diseases
  • Have vaccinations before and after the splenectomy for added protection. Ask your doctor for pneumococcal (Pneumovax 23), meningococcal, and haemophilus B influenzae type-B (HiB) vaccines, which will give you protection against pneumonia, meningitis, and blood infections. Note that you need to have pneumococcal vaccine every five years after the surgery.
  • Seek medical attention immediately if you have a fever, which is a possible sign of infection.
  • Take penicillin (under the doctor’s supervision) and other antibiotics before and after a splenectomy and if the doctor suspects a possible infection.

6 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with enlarged spleen.

An enlarged spleen is susceptible to rupture, which can cause massive internal bleeding, so you have to avoid contact sports like hockey, soccer, or football. When riding a car, always wear a seatbelt to prevent spleen injuries common in car accidents.

Problems in the spleen like enlarged spleen, or having no spleen, raise your risk of infections.

Always have vaccinations up to date. This means you need to have a flu shot every year, and boosters for tetanus, diphtheria, and whooping cough every ten years. You can discuss your vaccination needs with your doctor.

The spleen is more than just an organ capable of managing blood cells. It also helps turn nutrients from digested foods into a useable fuel, thus producing energy for the body. An unhealthy spleen is seen as a key contributor for diseases like anemia and fatigue. It can also have an impact on how the other organs work, including the liver, rectum, stomach, uterus, and colon. One of the best ways to maintain a healthy spleen and entire lymphatic or digestive system is to have a diet rich in antioxidants, minerals, vitamins, and essential fluids. Maintaining a healthy diet helps lower instances of inflammation and fights free-radical damage, which could worsen an enlarged spleen.

Include a diet that is high in plant foods, which will also provide enough hydrating water. This is very important, since it helps the spleen get rid of any excess fluids or foreign particles. One should avoid foods that could place stress on the circulatory and immune systems. The liver, spleen, and other organs have to work harder if one eats too many foods that contain chemicals. Foods that can be eliminated from the diet are common allergens such as soy, dairy products, gluten, sugary snacks, animal products of lesser quality, refined vegetable oils such as sunflower, soybean, or safflower, and any processed foods that contain high amounts of chemical sprays or toxins.

One should also exercise regularly. This helps flush out waste from the body once the spleen and liver finish cleansing. Chronic stress can lead to various problems that ultimately weaken the immune system, hence, one should avoid any kind of stress and try meditation or deep breathing activities to help lower stress levels.

7 Risks and Complications

Anyone with diseases that can affect the spleen is at risk for enlarged spleen. However, the following people face a higher risk:

Enlarged spleen can cause serious complications, such as severe anemia, and lower resistance to infections.

In addition, an enlarged spleen is prone to rupture and can cause massive internal bleeding. Car crashes and physical trauma can cause an enlarged spleen to rupture.