Description

The spleen is an organ located just below your left rib cage. Many conditions — including infections, liver disease and some cancers — can cause an enlarged spleen. An enlargement of the spleen is known as splenomegaly (spleh-no-MEG-uh-lee).

An enlarged spleen usually doesn't cause symptoms. It is often discovered during a routine physical examination. A doctor generally can't feel the spleen of an adult, unless it is extended. Imaging and blood tests can help identify the cause of an enlarged spleen.

The treatment for an enlarged spleen depends on what is causing it. The surgery to remove the enlarged spleen is usually not necessary, but is sometimes recommended.

Symptoms

An enlarged spleen usually doesn't cause signs or symptoms, but sometimes it causes:

  • Pain or feeling of fullness in the left upper abdomen that may spread to the left shoulder
  • A feeling of fullness without eating or after eating a small amount because the spleen pressing on your stomach
  • Low red blood cells (anemia)
  • Frequent infections
  • Bleeding easily

When to see a doctor

See your doctor right away if you have pain in your upper left abdomen, especially if it is severe or the pain gets worse when you take a deep breath.

Causes

A series of infections and diseases that can cause an enlargement of the spleen. The expansion may be temporary, depending on the treatment. Contributing factors include:

  • Viral infections such as mononucleosis
  • Bacterial infections, such as syphilis or an infection of the heart's inner lining (endocarditis)
  • Parasitic infections such as malaria
  • Cirrhosis and other diseases that affect the liver
  • Several types of hemolytic anemia — a condition characterized by the premature destruction of red blood cells
  • Cancers of the blood, such as leukemia and myeloproliferative neoplasms, and lymphomas, such as Hodgkin's disease
  • Metabolic disorders, such as Gaucher disease and Niemann-Pick disease
  • The pressure on the veins in the spleen or the liver, or a clot of blood in these veins
  • Autoimmune diseases, like lupus or sarcoidosis

How the spleen works

The spleen is hidden below your rib cage next to his stomach on the left side of his abdomen. Size usually refers to your height, weight and sex.

This soft, spongy organ performs several critical jobs, such as:

  • The filtering and the destruction of old, damaged cells of the blood
  • The prevention of infection through the production of white blood cells (lymphocytes) and who acts as a first line of defense against disease-causing organisms
  • The storage of red blood cells and platelets, which help your blood to clot

An enlargement of the spleen affects each one of these jobs. When it is enlarged, the spleen may not work as usual.

Risk factors

Any person can develop an enlarged spleen at any age, but certain groups are at higher risk, including:

  • Children and young adults with infections, such as mononucleosis
  • People who have Gaucher disease, Niemann-Pick disease, and several other inherited metabolic disorders affecting the liver and the spleen
  • The people who live in or travel to areas where malaria is common

Complications

The potential complications of an enlarged spleen include:

  • Infection. An enlarged spleen can reduce the number of red blood cells, platelets and white blood cells in the blood, which leads to more frequent infections. Anemia and increased bleeding are also possible.
  • Rupture of the spleen. Even healthy in the spleen are soft and easily damaged, especially in car accidents. The possibility of rupture is much higher when the spleen is enlarged. A ruptured spleen can cause life-threatening bleeding in the abdomen.

Diagnosis

An enlarged spleen is usually detected during a physical examination. Your doctor can often feel it by gently examining your left upper abdomen. However, in some people, especially those who are slender — a healthy, normal-sized spleen can sometimes be felt during an exam.

Your doctor may order tests to confirm the diagnosis of an enlarged spleen:

  • Blood tests, such as a complete blood count to check the number of red blood cells, white blood cells and platelets in your system and the function of the liver
  • Ultrasound or a ct scan to help determine the size of the spleen and, if that is the overcrowding of other organs
  • The magnetic resonance imaging to trace the flow of blood through the spleen

Find the cause

Sometimes you will need more tests to find the cause of an enlarged spleen, including a bone marrow biopsy examination.

A sample of solid bone marrow may be removed in a procedure called a bone marrow biopsy. Or you could have a bone marrow aspiration, which removes the liquid portion of the cord. Both procedures can be performed at the same time.

Liquids and solids, bone marrow samples are usually taken from the pelvis. A needle is inserted into the bone through an incision. You will receive a general or a local anesthetic before the test to help with the discomfort.

A needle biopsy of the spleen is rare because the risk of bleeding.

Your doctor may recommend surgery to remove the spleen (splenectomy) for diagnostic purposes when there is an identifiable cause for the extension. Most often, the spleen treatment is withdrawn. After surgery to remove the spleen is examined under a microscope to check for possible lymphoma of the spleen.

Treatment

The treatment of enlargement of the spleen focuses on what is causing it. For example, if you have a bacterial infection, the treatment includes antibiotics.

Watchful waiting

If you have an enlarged spleen, but do not have symptoms and the cause cannot be found, your doctor may suggest watchful waiting. You consult your doctor for re-evaluation of 6 to 12 months, or earlier if symptoms occur.

Spleen removal surgery

If an enlarged spleen causes serious complications, or the cause may not be identified or treated, surgery to remove the spleen (splenectomy) may be an option. In chronic or critical cases, surgery may offer the best hope for recovery.

Elective removal of the spleen requires careful consideration. You can live an active life without a spleen, but you're more likely to get serious or even life-threatening infections after removal of the spleen.

To reduce the risk of infection after surgery

After the removal of the spleen, some steps can help to reduce your risk of infection, including:

  • A series of shots before and after splenectomy. These include the pneumococcal vaccine (Pneumovax 23), meningococcal, and haemophilus influenzae type b (Hib) vaccine, which protects against pneumonia, meningitis and infections of the blood, the bones and the joints. You will also have the pneumococcal vaccine every five years after the surgery.
  • Penicillin or other antibiotics after surgery and in any time that you or your doctor suspect the possibility of infection.
  • Call your doctor at the first sign of a fever, which could indicate an infection.
  • Avoid travel to areas of the world where certain diseases, like malaria, are common.

Lifestyle and home remedies

Avoid contact sports, such as soccer, football and hockey, and limit other activities recommended to reduce the risk of a rupture of the spleen.

It is also important to wear a seat belt. If you are in a car accident, a seat belt can help to protect your spleen.

Finally, make sure to keep your vaccinations up to date, because the risk of infection is higher. That means that at least an annual flu vaccine and the vaccine against tetanus, diphtheria, and pertussis booster every 10 years. Ask your doctor if you need other vaccines.

Symptoms and treatment of an Enlarged spleen (splenomegaly)