Spleen pain

introduction

The spleen is located near the stomach in the abdominal cavity, so that the spleen pain can usually be felt in the upper abdomen, although it can also radiate into the lower abdomen and the left shoulder (Kehr sign). Pressure pain on the left side of the neck (Saegesser sign) is also possible. It is not uncommon for those affected to suffer from pain-related breathing, which can also be recognized by the posture from outside. The spleen pain cannot be precisely differentiated in terms of its localization and is only diffuse. In order to be able to reliably assign the pain to the spleen, it is of great importance to know the accompanying symptoms.

Causes of Spleen Pain

Spleen pain can have various causes. The spleen can become more or less seriously ill with some diseases.
We will go into the following diseases in more detail:

• Rheumatoid arthritis
• Systemic lupus erythematosus (SLE)
• Rupture of the spleen
• Splenic congestion
• Sickle cell anemia
• Thalassemia
• Spleen pain after alcohol
• Spleen pain after eating
• Glandular Pfeiffer fever

Rheumatoid arthritis

Rheumatoid arthritis is an inflammation of the body that occurs in phases and mainly attacks the joints of the hands and feet.
Characteristic are swollen and especially in the morning stiff metatarsophalangeal joints (MetacarpophalangealJoints) and intermediate finger joints (proximal interphalangealJoints) on both sides.
The disease process of rheumatoid arthritis gradually leads to the destruction of the cartilage and bone structure and is difficult to stop with drugs such as cortisone and methotrexate. Nevertheless, one can treat the external symptoms like pain.

Systemic lupus erythematosus (SLE)

Systemic lupus erythematosus is an autoimmune disease. This means that the body's defense, which is normally supposed to protect against intruders, attacks the body's own tissue for reasons that are still unknown.
A lot of antibodies (small “pincers” that recognize and mark intruders) are created, which stick together and are deposited in different places in the body and cause damage there.
Typical signs of the SLE are:

• the redness of the skin on the face that is shaped like a butterfly (butterfly erythema)
• extensive and blotchy reddening of the skin (Lupus discoides)
• Photosensitivity
• Joint inflammation and joint pain.

In addition, the stuck antibodies can also be found in internal organs, such as

• the kidney
• the heart
• the central nervous system and
• the spleen

Cause damage. Attempts are made to treat systemic lupus erythematosus (SLE) with cortisone, pain relievers and agents that suppress the immune system (immunosuppressants, for example methotrexate).

For more information, see our topic: Lupus erythematosus

Rupture of the spleen

A ruptured spleen occurs when a large force is applied to the abdomen, as can be the case in an accident.
In addition, broken ribs with their sharp ends can break through the thin capsule that surrounds the spleen, causing bleeding into the abdomen due to the high blood flow to the spleen.
There is a risk that the body will go into shock as a result.

In the case of minor injuries to the spleen, the injury can be repaired with a specific tissue adhesive. Most of the time, however, the entire spleen has to be removed, because then hemostasis is easier.

You can find a lot more information under our topic: Rupture of the spleen

Splenic congestion

For example, due to a liver disease such as cirrhosis of the liver, the pressure in the blood circulation, which is connected between the intestine and liver (portal circulation) and in which the spleen is also integrated, is increased. Medically, this condition is called pford vein hypertension. This can lead to blood congestion in the spleen, which is then enlarged. An enlarged spleen breaks down more red blood cells, which can lead to anemia (haemolytic anemia).

Also read our topic: Swollen spleen

Sickle cell anemia

In sickle cell anemia, the structure of the red blood pigment (hemoglobin) is changed due to an inherited genetic characteristic. As a result, the red blood cells cannot take their usual shape, comparable to that of a round inflatable boat, and look more sickle-shaped.
These sickle cells are not as flexible as normal red blood cells and can therefore clog small vessels (for example in the spleen), which can interrupt the blood supply to important organs.
With regard to the severity of the manifestation, a distinction is made between whether a person still produces half of normal red blood pigment (heterozygous) or whether a person only produces modified pigment (homozygous). The latter case is much more serious.

Thalassemia

In thalassemia, the formation of red blood pigment can be disturbed in different ways.
Like sickle cell anemia, thalassemia is an inherited disease. The normal blood pigment binds the oxygen in order to transport it, whereas the altered blood pigment cannot bind the oxygen as well and therefore the various tissues may be insufficiently supplied.
Signs of anemia appear:

• Pallor of the mucous membranes
• fatigue
• a headache
• Racing heart.

Depending on the amount of the affected blood pigment, a distinction is made between a "small" minor form, a medium intermediate form and a severe major form. Blood transfusions or, in the case of the major form, a bone marrow transplant are possible therapy.

Spleen pain after alcohol

When consuming alcohol, there is often talk of liver damage, but the importance of the spleen in detoxification is usually underestimated. The spleen has a filter function for the blood system and is an important part of the immune system. All the blood in the body passes through the spleen and dead or damaged red blood cells are filtered out here. If this protective function fails, people are more susceptible to infections.

During the breakdown of alcohol in the liver, acetaldehyde is produced, which is very toxic and is responsible for damage caused by alcohol abuse throughout the body. The cell membranes, including those of the red blood cells, are attacked and indirect damage is caused, as a result of which they are increasingly broken down in the spleen and this in turn leads to an enlarged spleen.

Read more on the topic: Consequences of alcohol

Spleen pain after eating

Pain in the spleen after eating is rather untypical. As a rule, it is a coincidence of the times (after eating and the time of spleen pain). The spleen is an organ that plays an important role in the immune system and in sorting out old blood cells. This has primarily nothing to do with food and nutrition.

However, pain in the spleen area can occur after eating. Since the spleen and stomach are immediately adjacent, the symptoms are mostly due to stomach problems. An injury to the gastric mucosa (ulcer) can lead to pain after eating. Reflux disease, in which stomach acid flows back into the esophagus, is also associated with pain after eating. Since the esophagus is irritated by the strongly acidic gastric juice, burning pain occurs at the transition between the esophagus and stomach. These can lie in the immediate vicinity of the stomach and spleen or radiate behind the breastbone.

Spleen pain in pregnancy

During pregnancy, spleen pain can be caused in two different ways. On the one hand, there may be an infection, which, like the common cold, requires the spleen to work harder to select immune cells. Since special conditions prevail in the body during pregnancy, the immune system can overreact quickly and thus lead to increased swelling of the spleen.

However, at an advanced stage of pregnancy, pain in the spleen can also be due to a displacement mechanism. If the uterus becomes very large, it displaces the other abdominal organs. This can lead to increased pressure on the spleen and thus to pain.

Also read the article on the topic: Upper abdominal pain during pregnancy

Glandular Pfeiffer fever

Pfeiffer's glandular fever (also known as kissing disease) is a disease caused by the Epstein-Barr virus (EBV). The pathogens are typically transmitted via saliva (e.g. when kissing - hence the name). They mainly settle in the lymphatics, lymph nodes and lymphatic organs (spleen and liver).

In most cases, tonsillitis also occurs with a severe sore throat. Swelling of the lymph nodes (especially the neck) is very common, and the liver and spleen are also swollen in up to 50% of cases. The severe swelling of the spleen can cause pain in the left upper abdomen. A dreaded complication is the rupture of the spleen, which can lead to heavy or life-threatening bleeding.

You might also be interested in: Symptoms of Pfeiffer's glandular fever

Concomitant symptoms

Depending on the cause of the pain, the accompanying symptoms are always different. In the case of an enlarged spleen due to an infection or inflammation, the typical symptoms of infection can be present, such as fever, nausea, severe vomiting, abdominal cramps, diarrhea as well as headaches and body aches.

In so-called hemorrhagic shock, the symptoms are more severe. This results in sudden onset of shock symptoms with previously experienced trauma and symptom-free intervals over a few days and weeks.

Metabolic diseases, including hypersplenism, can be associated with thrombopenia and anemia and can be recognized in the blood count.

The spleen pain can also indicate an advanced spleen tumor. Further symptoms of a tumor are the so-called B symptoms with fever, weight loss and night sweats.

Read more on the topic: These symptoms indicate a ruptured spleen

nausea

Nausea is also a symptom that is not initially associated with the spleen. It occurs more often in the context of gastrointestinal infections or bad food. However, other abdominal diseases can also lead to nausea with vomiting. Often, either the blood supply to the stomach or the pressure from other organs on the stomach play a role in the development of nausea. For example, an enlarged spleen can back up the blood in the splenic artery, overloading the gastric vessels, which can cause stomach problems such as nausea and vomiting.

In addition, an enlarged spleen can irritate the stomach due to its close proximity to this organ and thus lead to nausea. Another mechanism is due to the nerve structures in the abdomen. Not every organ has its own nerve fibers that can transmit pain information to the brain. Rather, pain is perceived very unspecifically in a larger abdominal region. For example, pain in the spleen can be mistakenly interpreted by the brain as stomach pain and thus lead to further symptoms such as nausea.

cold

In the case of a cold, the spleen plays an important role as a lymphatic organ. A selection process for the immune cells takes place in this organ, so that strong immune cells enter the body and weak or “incorrectly programmed” cells are sorted out and destroyed. With a cold, the immune system is challenged; as many immune cells as possible have to be produced and selected so that an adequate fight against the pathogens can take place.

This can overstrain both the lymph nodes and the spleen, leading to swelling of the lymph nodes and spleen and causing pain in the affected areas.

Read more on the topic: Lymphatic organs

Swelling of the lymph nodes

Since the spleen is a lymphatic organ, swelling of the lymph nodes and swelling of the spleen often go hand in hand. There is usually no spleen swelling that causes pain that is not associated with swelling of the lymph nodes.
The typical example is Pfeiffer's glandular fever, which presents with pronounced swelling of the cervical lymph nodes and is often associated with splenomegaly (enlargement of the spleen). Pain in the spleen with swelling of the lymph nodes usually suggests an infection with a pronounced reaction of the immune system.

Read more on the topic: Swelling of the lymph nodes

Which doctor treats spleen pain?

Those affected with spleen pain usually go to their family doctor with complaints of abdominal pain, whereupon the doctor conducts a detailed survey and then feels the stomach as part of a physical examination. It is not difficult to attribute the abdominal pain to the spleen, as only an enlarged spleen can be felt. The enlarged one can also be seen in the ultrasound examination.

In addition, the family doctor can request blood tests, which can lead to hypersplenism with thrombopenia (reduction in blood platelets) and anemia (anemia).

In inconclusive cases or suspected rupture of the spleen, a referral to a radiologist for an MRI or CT may be required.

When should you go to the doctor?

Pain in the spleen is uncommon and usually indicates a pronounced infection or more serious illness. Pain in the left upper abdomen that cannot otherwise be explained should be examined by a doctor. The doctor can quickly determine whether the spleen is swollen and enlarged by palpating the abdomen.

An enlarged spleen can also be quickly diagnosed on ultrasound. Anyone who can feel their spleen under the costal arch in the left Oberbach should also consult a doctor. Even experienced examiners often cannot find the normal size spleen, so if the spleen can be palpated, it is always enlarged.