spleen

Synonyms in a broader sense

Medical: Splen, Lien

Ruptured spleen, immune defense, thrombocytes, blood platelets

English: whimsy

Anatomy of the spleen

The spleen is an organ located in the abdominal cavity (abdomen) that performs various functions. It is roughly the size of a kidney and hugs the upper left abdomen against the diaphragm, the stomach and the left kidney.
The average size of the spleen is 4x7x11 cm.
Wedged between other organs, their shape is often compared to that of an orange segment. Since the spleen is so close to the diaphragm, it moves with the breathing, but of normal size it is mostly covered by the ribs and so cannot be felt from the outside.
On the one hand, it is activated as a filter station in the bloodstream and, on the other hand, it plays an important role in defending against "intruders" in the body, i.e. the spleen is part of the immune system.
It is also part of the lymphatic system.

These different functions are also noticeable in terms of color. The spleen blood filter is red and the area responsible for defense appears white (red pulp and white pulp).
The organ is made up of a very soft material (pulp) and only gets a little stability from a thin capsule (and fibers that extend from the capsule into the interior).
For the blood filtering function of the spleen, it is very important that a large artery (artery) supplies blood and an equally large vein drains the blood away.

Illustration of the spleen

spleen
(Organ of the lymphatic system)

1. Spleen - Splen, Lien
2. Spleen capsule -
   Flushes, capsules
3. Red pulp
4. White pulp
5. Barbed artery -
   Trabecular artery
6. Bar vein -
   Trabecular vein
7. Diaphragm - Diaphragm
8. Stomach body -
   Corpus gastricum
9. Splenic artery -
   Splenic artery
10. Splenic vein -
    Splenic vein
11. Spleen hilum - Hilum splenicum
    A - projection of the internal organs
    on the anterior chest and abdominal walls

You can find an overview of all Dr-Gumpert images at: medical illustrations

Function of the spleen

The spleen can be thought of as a sponge into which the blood is pressed. The red blood cells (Erythrocytes) that are still young and flexible can slip through the mesh of the sponge, whereas the old ones (usually around 120 days old) get caught in it and are broken down.

The defense function of the spleen can be described as a parking lot or assembly point for white blood cells (leukocytes). The white blood cells do not swim continuously in the bloodstream, but collect at different points in the body, for example in the spleen.
In contrast to the lymph nodes, which are a filter station for a specific region in the body, the spleen is a filter station for the entire bloodstream.
The white pulp, which is responsible for the defense, is grouped around the vessels as a lymphatic sheath (vagina periarterialis lymphatica) and as a spleen nodule (Malphigi body).
The white blood cells that play the most important role in the spleen defenses are called lymphocytes.

Read more on this topic at: What functions and tasks does the spleen have?

They wait in the white pulp in order to be able to react to pathogens that have washed past or to return to the blood after a certain period of time and to patrol the bloodstream.
So does the spleen in one Blood poisoning, in which bacteria multiply in the blood, play a special role. New lymphocytes can also form in the white pulp of the spleen.

Although the spleen has important functions, it is not a vital organ.
For example, if it is injured in an accident and bursts because of the thin capsule (Ruptured spleen / Rupture of the spleen), it is necessary to remove it due to the strong blood flow. The tasks of the spleen are then taken over by the liver and other organs, whereby one can be more susceptible to infections.
Especially in children whose defense system against pathogens is not yet fully developed, the spleen would not be removed lightly. After a spleen has been removed, you have to be vaccinated against certain diseases or certain pathogens, for example against one Meningitis and lung infection. The pathogens responsible for this are the so-called Pneumococci, Menigococci and Haemophilus influenzae.

Tasks of the spleen

Various important tasks can be assigned to the individual parts of the spleen. The red pulp the spleen consists of one well-perfused connective tissue network (Technical term: Splenic reticulum) that of sorting red blood cells (Erythrocytes) serves. Old red blood cells cannot pass this elastic structure and get caught. Then the sorted out old erythrocytes of the body's own Phagocytes (Macrophages) reduced become. Another important task of the spleen is recycling certain components of the red blood cells. Especially the im red blood pigment (hemoglobin) iron contained in the spleen can be retained and then recycled. In addition, one of the roles of the spleen is small Blood clots and consumed Platelets (Platelets) from the bloodstream and dismantle.

Another anatomical structure of the spleen, the white pulp, in turn, has other tasks. As part of the Immune system their main tasks are Defense against viral and bacterial pathogens. In the course of this, the spleen serves as a Storage organ for a certain class of white blood cells called lymphocytes. On average, about 30 percent of the Lymphocyten stored in the spleen. Also the "Training" this group of white blood cells is one of the most important tasks of the spleen. If infectious agents reach the spleen via the bloodstream, an infection can be warded off immediately on site. In addition, one of the tasks of the spleen is to feed lymphocytes into the bloodstream when necessary. Furthermore belongs the Formation of antibodies (Immunoglobulins) in the white pulp is one of the most important tasks of the spleen. In addition, the spleen stores certain amounts of blood as a kind of blood sponge. For this reason, if the organ ruptures, enormous amounts of blood are released in a very short time. The regular release of the stored blood volume is induced primarily during physical exertion. This is commonly called a "Side stitch" perceived. One of the roles of the spleen as a child is growing in the womb is also to produce blood.

Diseases of the spleen

The spleen can be enlarged in the context of other diseases, which can manifest itself as both over and underfunction. This magnification is good in Ultrasonic to see (sonography).

When the body fights against "intruders", for example viruses, bacteria or parasites, as is the case with the malaria If this is the case, the defense tissue of the spleen increases.
Even if the defense is against the body's own structures, in autoimmune diseases, the spleen can be enlarged. Examples are the Rheumatoid arthritis and Lupus (systemic lupus erythematosus).

The spleen can also be enlarged due to blood congestion and the associated increased blood filling. This can damage the spleen tissue. Congestion occurs in liver diseases like the Cirrhosis of the liver and if the right heart is weak (Right heart failure) on.

Are the red blood cells (Erythrocytes) for example changed in their form by genetic causes, as it is with the Sickle cell anemia or Thalassemia If so, they tend to get caught in the meshwork of the spleen.
This breaks down red blood cells that are still needed and function well. The increased breakdown leads to the red blood pigment and its breakdown products circulating in the blood. This can be used for Jaundice (Jaundice) to lead. One way to solve the problem of unnecessary degradation is to remove the spleen - with all the consequences associated with it (see above).

The defense tissue of the spleen (lymphoid tissue) can also grow excessively, so that both benign and malignant tumors of the spleen are known. Malignant tumors are for example Blood cancer (leukemia) and Lymphoma. Daughter tumors (metastases) of other malignant tumors can also settle in the spleen.

Spleen is enlarged - is that dangerous?

The term spleen enlargement (spleen enlarged) denotes an extent of the organ that exceeds the norm. Depending on the case, the term enlarged spleen can mean an increase in the size or weight of the organ. The spleen of a healthy person is approximately 11 cm long and 4 cm wide. The normal weight of the spleen (if it is not enlarged) is around 350 grams. The enlarged spleen (Splenomegaly) is in most cases not an independent clinical picture. Rather, the enlargement of the spleen is a specific symptom of a large number of underlying diseases.
For this reason, an enlarged spleen must always be perceived as a warning signal. In a healthy person, the spleen is usually not palpable under the left costal arch. Only changes in the organ structure ensure that the spleen enlarges and becomes palpable below the left costal arch. There are a number of reasons why an enlarged spleen may appear.

The most common diseases that lead to corresponding organ changes include:

• Infectious diseases (for example glandular Pfeiffer fever)
• Metabolic diseases
• Tumors

Accompanying symptoms of an enlarged spleen depend on the extent of the increase in organs and the underlying disease. For example, an enlarged spleen can exert pressure on neighboring organs and thus lead to more pain. In addition, an enlarged spleen is often associated with fever and / or joint problems, depending on the underlying disease. The most common causes of an enlarged spleen include both acute and chronic inflammation. In addition, diseases of the hematopoietic system (for example leukemia) are among the most common causes of enlargement of the spleen. Furthermore can Sarcomas (malignant tumors) or cysts (cavities filled with fluid) lead to an enlarged spleen. Patients who suffer from underlying lymphatic or rheumatic diseases often develop splenomegaly as the disease progresses. In addition, all diseases that affect the breakdown of blood affect the size of the spleen in most cases. In this context the so-called "Spheroidal cell anemia" a crucial role. This condition occurs because of the abnormal shape of the red blood cells (Erythrocytes) to an increased breakdown of blood within the spleen. In most cases, an enlarged spleen can be guessed at without a physical examination and palpation of the organ. Typical symptoms usually already indicate the presence of an enlarged spleen. The most common of these symptoms include:

• nausea
• Bloating
• Pain in the lower abdomen
• Anemia
• paleness
• Tiredness / weakness

Read more on this topic at: Swollen spleen

Symptoms in the spleen area suggestive of illness

Various diseases can occur in the area of ​​the spleen, which manifest themselves as both different and the same symptoms. The most common diseases of the spleen include:

• Hepathopathies
• Infections
• Storage diseases
• Spleen pain

Hepatopathies

The term "hepatopathies" actually describes a number of diseases of the liver. However, since most of these diseases also affect the spleen, they are the most common cause of enlargement of the spleen. The affected patients usually show classic symptoms of liver disease. These symptoms include pronounced fatigue and pain in the area of ​​the right upper abdomen. In addition, jaundice (Jaundice) come. In most cases, the symptom of yellowing can first be detected in the area of ​​the eyes (more precisely: on the sclera).

In relation to the spleen, portal high blood pressure causes the affected to significantly increase the size of the spleen tissue (Splenomegaly).

Infections

The differential diagnosis between the individual infections affecting the spleen is hardly possible on the basis of the symptoms. The affected patients show similar symptoms for almost all infectious underlying diseases. In particular, the occurrence of high fever and the inflammatory swelling of the lymph nodes are among the most common symptoms that can be observed in all infectious diseases. Ultimately, the diagnosis of the relevant diseases must be made with the help of a blood smear, bacteriological and serological tests.

The most common infectious diseases that affect the spleen include:

• Mononucleosis
• Toxoplasmosis
• Brucellosis
• Cytomegaly
• Bacterial endocarditis
• tuberculosis
• malaria
• Leishmaniasis

In the course of these infectious diseases, an increase in the size of the spleen tissue can be observed.

Storage diseases

The typical storage diseases that affect the spleen are M. Gaucher and M. Niemann-Pick. The diagnosis of these two diseases is based on a histological examination of the liver and bone marrow. Classic symptoms occur in the area of ​​the spleen in these diseases. In affected patients, the spleen can be palpated below the left costal arch. The original weight of the organ can double to over 300 grams in the course of one of these diseases. In addition, by displacing the stomach and some sections of the intestine, pain in the upper and lower abdomen is provoked. If the spleen increases in mass within a short period of time, a splenic infarction or capsule tension can develop. Classically, the symptom "sudden, severe pain in the lower abdomen" indicates this problem.

Spleen pain

Spleen pain is usually localized in the area of ​​the upper abdomen. However, they can also be located on the left side in the lower abdomen. Often a radiation of the pain can be observed, so that the entire left abdominal area is affected. In the case of very severe spleen pain, this can also be felt in the left shoulder. Since diseases of the spleen often lead to general physical exhaustion and additional accompanying symptoms, those affected are often very sensitive to pain and pain can also occur in other parts of the body.

In general, there can be many causes for the acute onset of spleen pain. The most common reasons for developing spleen pain include ruptured spleen, vascular occlusion (Splenic infarction) and inflammatory processes in the area of ​​the spleen capsule. In most cases, a ruptured spleen is the direct result of a traumatic event (such as a traffic accident). If a significant enlargement of the organ is palpable in addition to the occurrence of the spleen pain, this can be a first indication of a serious underlying disease. Above all, tumors of the spleen, infectious diseases such as Pfeiffer's glandular fever and various metabolic diseases often cause the symptom complex of spleen pain and palpable enlargement of the spleen. Patients who observe the acute onset of splenic pain should consult a doctor immediately. Pain in the spleen area always requires prompt medical clarification and the immediate initiation of appropriate treatment. Many of the possible causes can lead to serious complications if therapy is delayed. In the event of a traumatic rupture of the spleen with acute splenic pain, serious internal bleeding and, in the worst case, death can result. The diagnosis of spleen pain is divided into several steps. Depending on the constitution of the patient concerned, only a brief questioning is carried out by the attending physician. He tries to find out within a very short time which symptoms exist, where the spleen pain is localized and whether other symptoms (e.g. fever or fatigue) have been observed. In addition, the patient concerned is asked about possible traumatic events. Already during this doctor-patient conversation (anamnese), a blood sample is usually taken with a subsequent laboratory examination of certain blood values ​​(for example: hemoglobin, c-reactive protein, leukocytes, platelets, etc.). This is followed by an orienting clinical examination. During this examination, the attending physician tries to feel the spleen and to get a rough overview of the other abdominal organs. If there is a rupture of the spleen, this can usually be discovered during an ultrasound examination of the abdomen. If the findings are unclear, further imaging tests should be initiated. The treatment of spleen pain depends on the underlying disease. In the event of a rupture of the spleen with acute splenic pain, the organ is usually surgically removed. Compared to other organs in the human body, the spleen is important but not essential to life. For those affected, a reasonably normal life is possible even after the surgical removal of the organ.

Read more on the topic: Spleen pain

Inflammation of the spleen

The spleen and spleen capsule can become inflamed and cause extremely uncomfortable symptoms. Chronic inflammation can cause anemia and bleeding disorders. The spleen is a storage location for red blood cells (erythrocytes) and the platelets that are involved in clotting. As a result, a dysfunction of the spleen can lead to anemia due to a lack of erythrocytes and an increased tendency to bleed, since there is a lack of platelets for blood clotting.

The consequences of anemia are often tiredness, poor performance and difficulty concentrating. Both acute and chronic inflammation can cause severe pain. The pain is typically localized in the left upper abdomen below the costal arch and can radiate into the entire abdomen, back and left shoulder. The spleen is often swollen palpably and extremely painful on pressure.A splenicitis should be presented to a doctor immediately to rule out dangerous differential diagnoses, such as a splenic infarction, and to prevent chronic inflammation.

For more information, read on: The inflammation of the spleen.

Splenic infarction

A splenic infarction is an infarction of spleen tissue. A heart attack is the death of tissue as a result of insufficient blood flow due to insufficient blood flow (ischemia). This means that the spleen is insufficiently supplied with blood and spleen tissue perishes. Splenic infarction can have a number of causes, including leukemia, endocarditis, atrial fibrillation, thromboembolism, sepsis, and other diseases of the vessels and blood cells. The various causes lead to a narrowing or occlusion of blood vessels in the spleen and cause a reduced blood supply to the organ.

Splenic infarction is an acute clinical picture. Those affected have severe upper left abdominal pain, which occurs suddenly and can spread to the entire abdomen. Typical symptoms are nausea, vomiting, malaise, chills and fever. In the area of ​​the spleen, i.e. under the left costal arch, the patient suffers from severe pressure pain, which increases as the disease progresses. Other complaints are sudden sweats and a strong feeling of illness. The area under the left costal arch may be swollen and red.

Medically, splenic infarction falls under the collective term “acute abdomen”. A splenic infarction must be clarified immediately by a doctor. Depending on the cause of the infarct, immediate treatment may be vital. Furthermore, in the case of recurring splenic infarctions, a drug setting with anticoagulants may be necessary. Unfortunately, a splenic infarction is associated with a poor prognosis, as serious diseases such as myeloid leukemia or splenic vein thrombosis are often the cause.

Also read the article: The splenic infarction.

Spleen tumor

A spleen tumor is an overgrowth of tissue in the spleen. Benign tumors are, for example, growths from vascular cells such as hemangiomas and lymphangiomas or tumors from connective tissue cells such as lipomas and fibromas.

Malignant tumors of the spleen are rare; they destroy the spleen and can metastasize to the liver, heart and lungs. Possible symptoms are painful, palpable enlargement of the spleen (splenomegaly), clotting disorders, abdominal pain, vomiting, lack of appetite, night white, fatigue and weight loss.

Hemangioma in the spleen

A hemangioma in the spleen is a benign tumor, also called blood sponges, that originates in vascular cells. The tumor can be demarcated on imaging studies and cannot metastasize. Hemangioma typically causes splenomegaly. The spleen can enlarge so much that it can be felt under the left costal arch.

A hemangioma in the spleen can be harmless. However, if a hemangioma causes unbearable splenomegaly and dysfunction of the spleen, surgical removal may be indicated.

Find out more about the topic here: Hemangioma.

Remove spleen - what are the consequences?

Removing the spleen is called in medical terminology "Splenectomy" (Spleen removal). Surgical removal of the spleen creates a artificial asplenia (Spleness). The most common reason that the removal of the spleen becomes necessary is the traumatic rupture of the organ (rupture of the spleen). In addition, internal diseases that either cause the spleen to enlarge enormously or lead to life-threatening functional disorders can be an indication for the removal of the organ.
In the majority of cases, removing the spleen is an absolute emergency procedure that takes place immediately after the diagnosis has been made. However, there are also situations in which removing the spleen is possible as a non-emergency procedure.

The most common reasons for a splenectomy to be necessary include:

• Traumatic rupture of the spleen, for example due to a blunt abdominal trauma
• Hereditary spherocytosis
• Hereditary elliptocytosis
• Autoimmune hemolytic anemias
• Thalasemia requiring transfusion
• Sickle cell anemia requiring transfusion
• Werlhof's disease
• Thrombotic-thrombocytopenic purpura
• Myelofibrosis

In an emergency, surgical access to the spleen is made directly through the abdominal cavity. The spleen is then exposed and examined for a possible rupture. If the organ can be identified as the source of the bleeding, the bleeding must be stopped by local compression. If this succeeds, the condition of the spleen can be examined more closely and the further surgical procedure determined. The spleen is only removed in those cases in which definitive hemostasis is not possible without removing the organ. If this is not possible, the actual removal of the spleen begins with the careful separation of the connective tissue connections between the spleen and the tail of the pancreas. The blood vessels of the spleen are then clamped off and the organ removed. In cases where the removal of the spleen is planned to be carried out, a surgical incision is made along the left costal arch. In addition, laparoscopic removal of the spleen is possible in the absence of a source of bleeding. However, as with all surgical procedures, removing the spleen can lead to serious complications. The most common complications during spleen removal include problems with the respiratory system. Many patients develop pneumonia a short time after the spleen is removed. In addition, the formation of tiny over-inflated areas within the lung tissue and / or pleural effusions can occur. The spleen is an important organ, but not a vital one. However, removing the spleen can have a decisive impact on the lifestyle of the affected patient.

After removing the organ, there is a lifelong increased risk of bacterial infections and fungal diseases. The immune system is very weak due to a lack of B lymphocytes and decreased immunoglobulins. In addition, the lack of function of the spleen can cause a significant increase in the number of blood platelets (Platelets) to have. As a result, there is a risk of blood clots forming.

Normal size of the spleen

The normal size of the spleen is 11 cm x 7 cm x 4 cm. The spleen is about 11 cm long, 7 cm wide and 4 cm thick. Anatomically, one speaks of the "forty-seven-eleven rule". The size of the spleen can be determined sonographically with the ultrasound device. A length of 11 to 13 cm is considered normal. If the spleen is longer than 13 cm, it is called splenomegaly.

Back pain from the spleen - is that possible?

The spleen can actually cause back pain, which can make a diagnosis difficult. The pain that occurs in the spleen area often radiates to the abdomen and back, and occasionally to the left shoulder. In addition, back pain can also arise from the spleen if the pain in the spleen causes a bent, relieving posture, which annoys the back muscles, or if a severely swollen spleen becomes so large that it presses on other organs in the abdomen and there is pressure in the upper part Develops the abdomen and back.