The spleen is soft and spongy organ located just below the rib cage on the left side of the body and its functions include producing white cells to help fight infections, storing platelet and red blood cells, and filtering out and destroying old red blood cells every 110 to 120 days.
When the spleen enlarges, the condition is referred to as splenomegaly and the mentioned functions of the organ are negatively affected.
There are numerous issues that can cause splenomegaly and these may include the following:1
- Bacterial infections such as those that cause endocarditis and syphilis.
- Viral infections such as mononucleosis.
- Parasitic infections such as malaria.
- Various types of hemolytic anemias where there are damage and destruction to the red blood cells.
- Blood-related cancers such as Hodgkin’s and non-Hodgkin’s lymphomas, myeloproliferative conditions, and leukemias.
- Diseases that affect the liver such as cirrhosis as well as other conditions where the pressure is increased in the venous system of these organs such as blood clots forming in the veins.
- Metabolic conditions such as Niemann-Pick or Gaucher’s disease.
People of any age may develop a splenomegaly but there are groups of individuals who are at an increased risk of this condition such as:
- Children and young adults who contract the mentioned infections.
- Those who are prone to developing a metabolic condition such as those mentioned already.
Signs and symptoms
Splenomegaly may not cause any problems for the affected individual but if the organ enlarges enough they patient may present with signs and symptoms such as:
- A distended or full feeling in the left upper abdomen or pain in this area of the body which may get worse when breathing in.
- The pain may spread or refer to the left shoulder due to irritation of the diaphragm caused by the enlarged spleen.
- The enlarged spleen may push onto the stomach causing the patient to feel full quickly after eating or even having a reduced appetite and not wanting to eat at all.
- Anemia with associated dizziness, confusion, shortness of breath, heart palpitations and even darkly colored urine and yellow discoloration of the skin if the patient has hemolysis or liver pathology.
- Frequently contracting infections if the white cells are affected.
- Bleeding easily if the platelet count is low due to certain pathologies.
If the spleen gets large enough the following complications may arise:
- Rupture of the organ – the spleen consists of very soft tissue which already makes it a fragile organ in the body. When it enlarges, the chance of it tearing increases and if it does it may result in a life-threatening bleed in the body.
- Infection – a dysfunctional spleen due to its enlargement will result in a decreased number of white cells being produced by the organ and this can lead to more frequent and severe infections.
An enlarged spleen can be suspected on examination of the patient where the border of the organ can be felt in the abdomen. Normally the spleen is not felt at all because the entire organ is located under the rib cage.2
The diagnosis of splenomegaly can be confirmed on radiological investigations such as an ultrasound or MRI of the abdomen.
Patients with a splenomegaly without any symptoms or a clear cause of the problem are monitored every six to 12 months to assess the size of the spleen, or sooner if symptoms develop.
If the cause of the enlargement is determined then the underlying cause will be managed and treated appropriately and the spleen should return to its normal size soon thereafter.
If the enlarged spleen causes severe issues to the affected individual or the organ is enlarging and the cause cannot be determined then surgical removal of the organ (splenectomy) is warranted.