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Also called hypersplenism or splenomegaly, it occurs when the size of the spleen is increased by an infection or other medical conditions, including blood disorders.
This is an organ of the lymphatic system. Its function typically includes eliminating invading organisms in the blood (bacteria) of the circulation and producing antibodies for the immune system.
As well as the elimination of abnormal blood cells.
The spleen also maintains healthy red and white blood cells and platelets that help the blood clot.
The spleen is a bean-shaped structure located in the upper-left portion of the abdominal cavity, under the diaphragm, protected by the 9th to 11th ribs, in the middle part of the back.
The spleen can be enlarged by performing its normal functions in response to another medical condition.
Certain infections, diseases that affect blood cells, increased splenic blood flow, and conditions that invade the spleen are some of the most common reasons for the spleen to enlarge.
Splenomegaly is not always abnormal, and the size of the spleen does not necessarily say much about its function.
An average size spleen can not be palpated (felt) during the physical examination of the abdomen, except in thin people.
The enlarged spleen ( splenomegaly ) may be easier to palpate during a careful abdominal examination.
The spleen typically weighs 150 grams, about 5.3 oz., A typical adult extends approximately 11 cm or 4.3 inches vertically in its longest dimension.
Causes of an enlarged spleen
An enlarged spleen can be caused by infections, cirrhosis, and other liver diseases, diseases of the blood characterized by abnormal blood cells, problems with the lymphatic system, or other conditions.
There are some common causes for the patient to have an enlarged spleen, such as:
The infections:
- Viral infections, such as mononucleosis.
- Parasitic infections, such as toxoplasmosis.
- Bacterial infections, such as endocarditis (a condition of the valves in your heart).
Cancer:
- Leukemia: cancer in which white blood cells displace normal blood cells.
- Lymphoma: a cancer of lymphatic tissue, such as Hodgkin’s disease.
Other causes of an enlarged spleen include:
- Inflammatory diseases such as sarcoidosis, lupus, and rheumatoid arthritis.
- Trauma is like an injury during contact sports.
- Cancer that has spread in the case of metastasis to the spleen.
- A cyst, a sac filled with noncancerous fluid.
- A large abscess is a cavity filled with pus usually caused by a bacterial infection.
- They infiltrate Gaucher’s disease, amyloidosis, or glycogen storage diseases.
- Thalassemia disorder.
- Idiopathic thrombocytopenic purpura.
symptom
Most people can not know they have an enlarged spleen because the symptoms are infrequent.
The patient usually finds out during a physical examination.
Among the most common symptoms of an enlarged spleen are:
- The difficulties to being able to eat meals in large quantities. The appearance of this early satiety and the symptoms of gastric reflux. They are due to the displacement of the stomach and the pressure exerted on the stomach due to the enlargement of the spleen.
- There is a feeling of discomfort, fullness, or pain initially located in the upper left part of the abdomen, which can then extend to the left shoulder. This pain is very intense and usually gets worse when you take a deep breath.
Abdominal pain and swelling are the most common but not yet specific symptoms of an enlarged spleen.
Many of the signs and symptoms associated with the enlarged spleen are intimately related to the underlying cause of the inflammation.
Some of these can include:
- It usually produces generalized weakness, accompanied by fatigue.
- Anemia is the occurrence of frequent bleeding and weight loss.
- Infections may occur more frequently and have febrile symptoms.
- It can cause jaundice and paleness.
- The event of night sweats is another symptom that the swollen spleen can present.
- Easy bruising has been observed for no apparent reason.
In general, people who have splenomegaly symptoms can be seen by a doctor who manages the underlying cause.
For example, hematologists if the disease that causes it is a blood disorder.
Oncologists if the symptoms are caused by the suffering of cancer, and gastroenterologists if they are directly associated with the liver and the digestive tract.
These specialists usually deal with patients who may have enlarged spleen in response to another condition.
Diagnosis of inflamed spleen
The doctor will perform the medical history and a physical examination to help diagnose an enlarged spleen.
This involves feeling the spleen.
You may also need diagnostic tests to confirm the cause of the swollen spleen.
These may include blood tests, an ultrasound, a CT scan, and other tests that may be needed in some cases.
The most critical aspect in evaluating splenomegaly is finding the underlying cause.
In most cases, splenomegaly is detected incidentally in imaging studies, such as CT scans, performed for another reason.
The enlarged spleen can be felt by deep palpation in the left upper abdomen during the physical examination.
It is easier to feel, especially when the patient takes a deep breath and the diaphragm pushes the spleen down into the abdominal cavity.
A slightly enlarged spleen may not be appreciated in an abdominal examination but may be detected through other tests.
A complete blood count and blood smear are usually ordered within the laboratory tests to check the number, shape, and composition of white blood cells, red blood cells, and platelets if splenomegaly is detected.
Other blood tests that may be helpful include a metabolic panel or blood chemistry and liver function tests.
In addition to computed tomography, other imaging tests that can help evaluate splenomegaly include abdominal ultrasound, angiography, and liver and spleen scans.
Additional evaluation can be focused on determining the underlying cause of the splenomegaly guided by clinical reasons. For example:
- If the lymphoma is the suspected cause of an enlarged spleen, then CT scans of the chest and abdomen or a lymph node biopsy may be performed.
- When an infection is suspected, finding the source of the condition will become the main objective.
- A bone marrow biopsy can also be done if infections caused by Mycobacterium, Gaucher’s disease, or leukemia are considered.
- Splenectomy or removal of the spleen and microscopic analysis of the excised spleen can be performed if the risk of this surgery is compensated by the value of determining the exact cause to recommend the treatment subsequently.
Treatments
In many conditions, the spleen enlarges due to performing its normal physiological function in response to another existing medical condition, for example, cirrhosis.
The main goal is not necessarily to improve the splenomegaly that is only a consequence of the disease but to treat the underlying cause, such as cirrhosis.
In many other situations, such as infections, lymphomas, or leukemias, treatment must again be directed towards the underlying disorder using antibiotics or chemotherapy.
It is essential to seek specific treatment for the underlying cause of the inflamed spleen.
If this complication is not treated in time, an inflamed spleen can cause severe complications.
In most cases, treatment of the underlying cause of the inflamed spleen may prevent the removal of the spleen.
You should imitate any activity that can break your spleen, such as stress sports.
A ruptured spleen can cause the loss of much blood and endanger life
In the case of having surgery as the only option (removal of the spleen), the organism will not be able to eliminate certain bacteria from its body. It will be more vulnerable to the appearance of certain infections.
Therefore, once the procedures are performed, it is necessary to apply a treatment based on vaccines or other medications to prevent infections.
Surgery for the inflamed spleen:
Occasionally, the indicated treatment is the surgical removal of the spleen (splenectomy) to control the causal conditions.
A surgeon will likely remove the spleen if surgery is needed by using laparoscopy instead of open surgery.
This surgery is performed through small incisions in the upper midline of the abdomen, and with the help of a laparoscope, the surgeon can see and remove the spleen more easily.
Some conditions in which splenectomy may be considered are hairy cell leukemia, thalassemia major, splenic vein thrombosis, Gaucher’s disease, and idiopathic thrombocytopenic purpura.
Careful consideration should be given to the risks versus the benefits of surgery for the patient with the most prudent approach.
It is essential to note the importance of vaccination in those cases in which splenectomy is necessary.
People who do not have a spleen (asplenia) are at high risk of significant infections with organisms such as Streptococcus pneumonia, Neisseria meningitides, and Hemophilus influenzae.
Therefore, vaccination against these bacteria should be carried out.
These vaccines are called pneumococcal vaccine, meningococcal vaccine, and Hemophilus vaccine. These are necessary for any patient who undergoes a splenectomy.
Previously, using splenectomy as a treatment for splenic lesions was ideal.
However, over time and with the completion of multiple investigations, I became aware of the importance of the immunological functions of the spleen; the emerging trend now is to preserve it when possible.
Most splenic injuries are usually managed successfully with the help of conservative treatment.
Complications
Depending on the cause, which causes inflammation of the spleen, it can return to its standard size and function when the underlying disease has been treated or resolved.
- Commonly, in the case of infectious mononucleosis, the spleen returns to its standard size as the infection improves. So the treatment of the underlying disease eliminates the risk of later complications.
- When removing the spleen is part of the treatment, complications arise when the patient does not receive the indicated post-operative treatment since the patient is more susceptible to infections.
- Many diseases result in an enlarged spleen as a permanent physical finding. They can result in a permanent risk to the patient of being more prone to splenic injuries, infections, and abnormal bleeding.
Swollen spleen tracking
Follow-up with the attending physician is essential since many complications can occur if patients do not comply with the treatment and medical recommendations.
Prevention
The prevention of splenomegaly itself may be meaningless.
However, some of the medical causes of splenomegaly can be avoided, such as cessation of alcohol abuse to prevent liver cirrhosis or prophylaxis against malaria when planning a trip to an endemic area.
Preventive measures against a possible rupture of the spleen are worthy of mention.
Avoiding stress sports and wearing seatbelts are essential steps to prevent splenic rupture.
Adequate vaccination in patients with splenectomy is also of great importance to avoid the possible consequences of surgery.
recommendations
The patient who presents inflammation of the spleen must take into account the following considerations:
- It must stay well hydrated. This favors the lymphatic and depurative systems.
- A healthy and balanced diet should be followed, consuming foods rich in antioxidants in large quantities. Consume fruits, vegetables, and broth.
- Avoid all problematic foods to digest and usually complicate the digestive process, such as sugars, pastries, fried foods, and dairy products.
- The consumption of alcohol and sugary drinks should be avoided.
- The consumption of depurative infusions such as onion and olive oil, nettle tea, cranberry juice, and apple tea, in addition to hydrating the body, provides the beneficial properties of these foods.
