Enlarged Spleen: Etiology, Risk Factors, Signs, Symptoms, Investigations, Treatment
Spleen is quite a small-sized organ present below the ribcage on left side of body. The normal size of spleen is about that of fist. Some medical conditions such as infections, liver disease or some types of cancers can increase the size of spleen. This condition is called splenomegaly. Usually, many patients having splenomegaly do not have any symptoms at all and this condition is generally found during a routine physical assessment. Treatment for splenomegaly is done by way of treating its underlying cause. In some cases, surgery may be required to entirely remove the spleen.
Etiology And Risk Factors of Enlarged Spleen
- Bacterial infection like syphilis or endocarditis.
- Viral infections, such as mononucleosis.
- Parasitic infection, e.g. malaria.
- Different kinds of hemolytic anemia.
- Diseases affecting the liver such as cirrhosis.
- Lymphomas, such as Hodgkin's disease.
- Metabolic disorder like Niemann-Pick disease and Gaucher's disease.
- Compression or pressure on splenic veins or liver veins.
- Presence of blood clot in the above veins.
Risk Factor For Enlarged Spleen Are:
- Children and young adults suffering from infections like mononucleosis.
- African population have higher risk of developing splenomegaly due to complications from sickle cell disease.
- People from Ashkenazi Jewish community are at higher risk of Gaucher's disease, Niemann-Pick disease and other such inherited metabolic disorders where the liver and spleen are affected.
- Individuals living or travelling to regions where malaria is rampant are at higher risk of developing this condition.
Sign And Symptoms of Enlarged Spleen
- Some patients may not experience any symptoms at all.
- Common symptoms consist of pain in left upper part of abdomen which may radiate to the left shoulder.
- Patient may feel fullness in the left upper abdomen.
- Patient feels full after eating only a small amount of food or without eating also. This is due to the pressure of the enlarged spleen on the stomach.
- Recurrent infections.
- Patient bleeds easily.
- Serious symptoms are: Persistent and severe pain in the left upper abdomen or worsening pain upon a deep breath.
Investigations for Enlarged Spleen
- Physical exam.
- Blood tests to check the number of red blood cells, white blood cells and platelets.
- Ultrasound or CT scan helps in determining the dimensions of spleen and to check whether it is pressing on surrounding organs.
- MRI is helpful in tracing flow of blood through spleen.
- LFTs and bone marrow biopsies to find out the cause.
Treatment for Enlarged Spleen
Treatment depends on the cause. In case of an infection, antibiotics are given. In case of a cancer, chemotherapy and radiation are done. If patient suffers from serious complication or if underlying cause cannot be identified or treatment cannot be rendered, then surgery is done to remove spleen (splenectomy). Although patients can live a healthy life after splenectomy, there is a risk of catching serious infections after surgery. Certain steps should be taken to avoid post-splenectomy infection such as:
- Taking vaccinations pre and post splenectomy such as pneumococcal, meningococcal and haemophilus influenzae type B vaccines. These vaccines help in protecting against meningitis, pneumonia, or infection of blood, joints and bones.
- After operation, patient should be given antibiotics such as penicillin to avoid infection.
- Patient should avoiding travelling to areas where diseases like malaria are prevalent.
- Patients suffering from splenomegaly should also make some lifestyle alterations such as avoiding contact sports and restricting other activities or modifying activities to avoid risk of rupturing the spleen.
- Always wear a seatbelt so that if you are in an accident, it can prevent the spleen from getting injured.
- Make sure that you are always up-to-date on your vaccinations.