Internal Medicine

Enlarged spleen

Introduction - what is an enlarged spleen?

With an enlarged spleen (splenomegaly), as the name suggests, the size of the spleen changes. The increase in size can be triggered by a variety of diseases. An enlarged spleen is the result of an existing disease or a symptom and not an independent clinical picture.

Diseases with an enlarged spleen:

leukemia

Leukemia is a disease of the blood cells, especially the white blood cells, which are an important part of the immune system. In addition to many other symptoms, leukemia can lead to an enlarged spleen. This happens when the organ is infected with the diseased blood cells. In leukemia, due to the risk of the leukemic cells spreading, the spleen is checked along with other organs; this can be done using a palpation examination, ultrasound or CT / MRI.

Find out more about the following topics here:

blood cancer
How do you recognize leukemia?

Pfeiffer's glandular fever

In the case of Pfeiffer's glandular fever or mononucleosis, splenomegaly (enlargement of the spleen) can also occur. The triggering factor here is the increased immune response to the virus, in this case the Ebstein-Barr virus. Like the lymph nodes, the spleen is also one of the lymphatic organs that are involved in the fight against or immune defense. An infection with the Ebstein-Barr virus often caused a particularly strong reaction of the spleen, which outwardly represented an enlargement of the organ.

You can find out more about the topic here:

You can recognize Pfeiffer's glandular fever by these symptoms
Therapy of an Ebstein-Barr virus

Portal hypertension

Portal hypertension can also cause the spleen to enlarge. In the case of high blood pressure in the liver vessels or the portal vein, there is a reduced flow of blood through the organ. The disturbed drainage leads to blood congestion. The congestion then also affects other, especially upstream, vessels such as the spleen. Although the spleen primarily has nothing to do with the drainage difficulties, the backlog of the blood leads to an enlargement of the organ.

Find out more about the topic: Enlarged Liver

Storage diseases

Storage diseases are also a possible trigger for a large spleen. These include amyloidosis and mucopolysaccharidosis, among others.

In amyloidosis, proteins cannot be broken down properly. As a result, they are deposited in various organs, including the spleen or liver, and lead to an increase in volume there.

Mucopolysaccharidosis is an umbrella term for a large number of storage diseases that have to do with the storage of glycosaminoglycans. These, too, cannot properly be broken down and accumulate in the cells. Among other things, the spleen can be affected.

Autoimmune diseases

Autoimmune diseases can be accompanied by an enlarged spleen. Spleen enlargement is triggered by an abnormal response from the immune system, which includes the spleen. There is a multitude of autoimmune diseases, including collagenoses or diseases from the rheumatic environment, which can sometimes lead to an enlarged spleen. Which autoimmune diseases are actually involved in the presence of an enlarged spleen must be clarified on the basis of the other symptoms.

Collagenosis

The term collagenosis is an umbrella term for connective tissue diseases that are primarily of a chronic inflammatory nature. The collagenoses are among the autoimmune diseases and can sometimes be responsible for an enlargement of the spleen. The cause of the enlargement of the spleen is a disturbed immune reaction of the body as part of the disease.

The collagenoses include:

Lupus erythematosus
Sjogren's syndrome
Scleroderma
Dermatomyositis
Polymyositis

What is the size of a spleen from enlarged?

The spleen is about 4 cm high, 11 cm long and 7 cm wide. It lies protected under the left costal arch and usually cannot be felt. Exceptions to this are very slim people, with whom the spleen can occasionally be palpated without enlarging it. Extremely trained people can also be an exception. With you, the spleen can occasionally be very large as a normal variant. As a rule, if the spleen has increased in size by several centimeters, it is referred to as an enlarged spleen. The measurements can be easily determined using an ultrasound examination. If the spleen can be palpated 8 cm below the left costal arch in the physical examination of the upper abdomen, it is by definition an extreme form of splenomegaly.

diagnosis

The diagnosis of an enlarged spleen is usually made through a tactile examination and a subsequent ultrasound and / or CT examination. In many cases, a physical examination can reveal the magnification. To do this, the doctor feels under the left costal arch. In healthy people, the spleen can usually not be palpated. Very slim people can be an exception to this. With them, the spleen can occasionally be palpated without being enlarged. A visual representation with the ultrasound device or images with the CT then usually follow the palpation examination - they allow a more precise determination of the dimensions or the increase in size of the spleen.

Read more about the topic here: Swollen spleen

What do you see in the ultrasound?

Both the tissue structure and the size of the spleen can be assessed using ultrasound. The doctor can use measurements to check whether the spleen is larger than usual. Usually the practitioner makes different sectional images here. z. B. once lengthways and then across and measures the length or width of the organ using the ultrasound program. On the basis of the measurements, the doctor can provide information about an increase in the size of the organ.

Can you tell if you have an enlarged spleen from your blood values?

An enlarged spleen can also cause changes in blood values. This is due to the hypersplenism (spleen pain), i.e. an overactive spleen (the spleen filtered "too many" components out of the blood), which often shows up when the spleen is enlarged.

The changes mainly affect the red and white blood cells. They then appear in lower numbers in the blood test. The number of blood platelets, the so-called thrombocytes under the enlarged spleen, may also decrease. The blood test is a routine test that is usually done every time the spleen is enlarged.

Can you feel the spleen yourself?

If the spleen enlarges beyond a certain size, it can be palpable. As a layperson, however, it can be difficult to feel the spleen yourself. If necessary, the attending physician can provide guidance. If they suspect an enlargement, non-medical professionals should always consult a doctor. With trained hand movements and imaging procedures, he can better assess an enlargement of the spleen and also rule out other causes that could lead to masses in the upper abdomen.

I recognize an enlarged spleen by these symptoms!

Occasionally, an enlarged spleen causes discomfort in the left upper abdomen. A feeling of fullness that sets in quickly is also possible if the stomach is constricted by the size of the spleen. With high magnification it can also cause pain. Much more often, however, those affected suffer from the other symptoms of the underlying disease. Even if the symptoms mentioned above do not occur, the presence of an enlarged spleen is possible and should best be checked by an ultrasound examination.

I inform you here on the topic: Spleen pain

Pain

Pain can occur in the context of an enlarged spleen in the upper abdomen. If the symptoms are very severe, a splenic infarction should always be considered. It is a stroke of the spleen that can occur when the supplying vessels become blocked, for example in the context of leukemia.
Find out more about the topic: Upper abdominal pain and burning sensation in the upper abdomen

nausea

Nausea is a possible symptom associated with an enlarged spleen. Presumably, the nausea is caused by the lack of space the stomach experiences due to the expansion of the spleen. Furthermore, there may be a feeling of fullness, a feeling of fullness that sets in quickly when eating and / or stomach pain.

Learn more about the topics:

Abdominal pain and nausea
Abdominal pain in the upper abdomen

Treatment and therapy

Therapy for an enlarged spleen depends on its cause. Since there are a number of diseases that can trigger an enlarged spleen, there are many different therapeutic measures.

Pfeiffer's glandular fever is often only treated symptomatically, i.e. with painkillers. Occasionally, drugs that are supposed to fight the viruses are also used.
Find out more about the topic: Treatment of Pfeiffer's glandular fever

The treatment approach for leukemia is often chemotherapy. In the presence of autoimmune diseases such as B. arthritis, drugs that act on the immune system, so-called immunosuppressants, are often administered.

If the enlargement of the spleen cannot be treated otherwise, removal of the spleen can also be considered. The splenectomy, i.e. the removal of the spleen, comes into consideration above all if the enlargement of the spleen is also accompanied by a severe overfunction of the organ. The excessive work leads to the breakdown of cells that are still usable. In such cases, removal of the spleen can be useful.

Duration and forecast

The duration and prognosis of a spleen enlargement depend on the underlying disease. Accordingly, they cannot be given a blanket term. Certain complications of an enlarged spleen, such as a ruptured spleen, can also influence the prognosis. It is a ruptured spleen that is life threatening. The rupture of the spleen is relatively rare in blood diseases such as leukemia. However, due to the risks or mortal danger associated with its occurrence, it can be associated with a poor prognosis.

Find out more about the topic here: How do I recognize a ruptured spleen?

When are the spleen and liver enlarged?

Doctors also speak of hepatosplenomegaly when the volume of both organs increases at the same time. Infectious diseases such as Pfeiffer's glandular fever, cytomegalovirus or malaria are possible causes. Furthermore, tumors can be responsible for an enlargement. Liver diseases or so-called storage diseases such as amyloidosis are also possible triggers. Furthermore, diseases of the lymphatic system or blood diseases can lead to an enlargement of the liver and spleen. In order to find the trigger in hepatosplenomegaly, further diagnostic steps are usually required, taking into account other symptoms. These include, for example, blood draws, physical examinations or imaging tests.

Can you do sports with an enlarged spleen?

If the spleen is enlarged, certain sports such as soccer, handball, basketball or martial arts are not recommended. The reason for the prohibition is the danger of a rupture of the spleen. As the organ increases in size, it can tear more quickly. In contact sports in particular, there is an increased risk of such a complication. If the spleen is enlarged, it is best to do sports after consulting the attending physician. They can also offer advisory support in finding a suitable, less risky sport.