Our spleen is an organ located just below the left rib cage. Many conditions, including infection, liver disease, and certain cancers, can cause an enlarged spleen, also known as splenomegaly.
What is an enlarged spleen?
An enlarged spleen is a condition that is usually discovered during routine examination and is sometimes observed without causing symptoms. To better understand what is spleen enlargement and its consequences, first of all, it is necessary to talk about its functions in the body.
Your spleen is located on the left side of your abdomen, near your stomach, under your rib cage. It is a soft and spongy organ in structure. The main duties of the spleen can be listed as follows:
- It filters and destroys old, damaged blood cells.
- It produces white blood cells (lymphocytes). It prevents infection by acting as the first line of defense against disease-causing organisms.
- It stores red blood cells and platelets that help blood clot.
Spleen enlargement affects each of these vital functions. As your spleen grows, normal ones, as well as abnormal red blood cells, are filtered out, and the number of healthy cells in the bloodstream decreases. At the same time, too many platelets are trapped. Excess red blood cells and platelets can eventually block the spleen and affect its normal functioning. As a result of spleen enlargement, blood flow may be insufficient and this may damage some parts of the organ.
What are the symptoms of an enlarged spleen?
Although splenic enlargement does not show symptoms in some cases, the following symptoms can sometimes be observed:
- Pain sensation in the left upper abdomen that can spread to the left shoulder
- Feeling bloated or easily satiated after eating or eating less because of pressure on the stomach
- Anemia (anemia)
- Common infections
- Easy bleeding
What causes an enlarged spleen?
Several infections and diseases can cause an enlarged spleen. In some cases, spleen enlargement may be temporary depending on the treatment. The causes of spleen enlargement can be listed as follows:
- Viral infections such as mononucleosis
- Bacterial infections such as syphilis or an infection of the inner lining of the heart (endocarditis)
- Parasitic infections such as malaria
- Cirrhosis and other diseases affecting the liver
- Various types of hemolytic anemia (a condition characterized by the premature destruction of red blood cells)
- Blood cancers such as leukemia and myeloproliferative neoplasms and lymphomas such as Hodgkin’s disease
- Metabolic disorders such as Gaucher disease and Niemann-Pick disease
- Pressure on the veins in the spleen or liver or blood clots in these veins
What are the risk factors for an enlarged spleen?
Anyone can develop an enlarged spleen at any age. However, the following groups are at higher risk:
- Children and young adults with mononucleosis infections
- People with Gaucher disease, Niemann-Pick disease, and some other inherited metabolic diseases that affect the liver and spleen
- People living or traveling in areas where malaria is common
What are the complications of an enlarged spleen?
Potential complications of an enlarged spleen can be listed as follows:
- Infection: An enlarged spleen causes a decrease in the number of healthy red blood cells, platelets, and white cells in the bloodstream, leading to more frequent infections. In addition to infection, anemia and increased bleeding are also complications.
- Spleen rupture: Even healthy spleens are easily damaged, especially in accidents such as car crashes. When the spleen is enlarged, it is much more likely to rupture. A torn spleen can cause life-threatening bleeding in your abdominal cavity.
How is an enlarged spleen diagnosed?
An enlarged spleen is usually detected during a physical exam. Your doctor can usually feel this by gently examining your left upper abdomen. Your doctor can confirm the diagnosis of an enlarged spleen by ordering one or more of the following tests:
- Blood tests, such as a complete blood count to check the number of red blood cells, white blood cells, and platelets in your system
- Ultrasound or computed tomography (CT) scan to determine the size of your spleen and whether it is compressing other organs
- Magnetic resonance imaging to monitor blood flow through the spleen
Imaging tests are not always needed to diagnose an enlarged spleen. However, if your doctor recommends imaging, there is usually no special preparation needed for an ultrasound or MRI. If you are having a CT scan, you may need to avoid eating before the test. If you need to prepare, your doctor will inform you in advance.
Sometimes more tests such as liver function tests and a bone marrow exam may be required to find the cause of the enlarged spleen. These tests can provide more detailed information about your blood cells than blood taken from a vein.
In a procedure called a bone marrow biopsy, a solid bone marrow sample can be taken, and a liquid sample can be taken from the bone marrow by bone marrow aspiration. In many cases, both processes are done at the same time. Both liquid and solid bone marrow samples are usually taken from the pelvis. A needle is inserted through a small incision into the bone. General or local anesthesia is applied before the test to alleviate discomfort.
How is spleen enlargement treatment done?
Treatment for the spleen focuses on the underlying problem. For example, if you have a bacterial infection, treatment will include antibiotics. Antibiotics do not work in a viral infection.
- Careful waiting (waiting and observing): If an enlarged spleen has been diagnosed but no symptom or cause is found, the physician may recommend that you wait carefully. You should see your doctor immediately if you develop any symptoms, but within 6 to 12 months for reassessment if you do not.
- Spleen removal surgery: If an enlarged spleen causes serious complications or if the cause cannot be identified or treated, surgical removal of the spleen (splenectomy) may be an option. In chronic or critical situations, surgical intervention may offer the best hope for recovery.
Spleen removal surgery is an important decision. You can live an active life without a spleen, but you are more likely to develop serious, even life-threatening infections after spleen removal. Therefore, some precautions should be taken. In some cases, radiation can constrict your spleen so that surgical intervention may not be required.
REDUCING THE RISK OF INFECTION AFTER SURGERY
After the spleen is removed, some steps listed below can help reduce the risk of infection:
- Vaccination before and after splenectomy: It is very important to have pneumococcal, meningococcal, and Hemophilus influenza type b (Hib) vaccines that protect against dangerous diseases such as pneumonia, meningitis, blood, bone, and joint infections, and renew these vaccines as required. For example; After surgery, the pneumococcal vaccine should be administered every five years, flu every year, and tetanus every 10 years.
- You may need to use penicillin or other antibiotics after surgery and when you or your doctor suspect a possible infection.
- A doctor should be consulted at the first sign of fever because fever is an indication of infection and should be treated quickly.
- Traveling to some parts of the world where certain diseases such as malaria are common should be avoided.
POINTS TO CONSIDER AND LIFESTYLE CHANGES AT HOME
- You should avoid sports that can cause close contact such as football, American football, hockey, basketball, and do the activities recommended by your doctor. Changing your activities can reduce the risk of a ruptured spleen.
- Wearing seat belts is a vital precaution that many people don’t care about. In the event of a car accident, the seat belt can prevent damage to the spleen.
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