Diseases of the spleen

The spleen may be enlarged in the context of other diseases, which can manifest itself as both hyper- and hypofunction. This enlargement is clearly visible in ultrasound (sonography). When the body fights against “invaders”, for example viruses, bacteria or parasites, as is the case with malaria, the defence tissue of the spleen multiplies.

Even when the body’s defenses turn against its own structures, in the case of autoimmune diseases, the spleen may be enlarged. Examples are rheumatoid arthritis and lupus (systemic lupus erythematosus). The spleen may also be enlarged due to blood congestion and the resulting increased blood filling.

This can damage the spleen tissue. Congestion occurs in liver diseases such as cirrhosis of the liver and weakness of the right heart (right heart failure). If the red blood cells (erythrocytes) are altered in their form, for example by genetic causes, as is the case with sickle cell anemia or thalassemia, they are more likely to get stuck in the mesh of the spleen.

In this way, red blood cells are broken down, which are still needed and function well. The increased breakdown causes the red blood pigment and its breakdown products to circulate in the blood. This can lead to jaundice (icterus).

One way to solve the problem of unnecessary degradation is to remove the spleen – with all the consequences that this entails (see above). The defense tissue of the spleen (lymphatic tissue) can also grow excessively, so that both benign and malignant tumors of the spleen are known. Malignant tumors include blood cancer (leukemia) and lymphomas.

Daughter tumors (metastases) of other malignant tumors can also settle in the spleen. The term splenomegaly (enlargement of the spleen) refers to a degree of the organ that exceeds the norm. Depending on the case, the term enlarged spleen may mean an increase in the size or weight of the organ.

The spleen of a healthy person has an approximate length of 11 cm and a width of 4 cm. The normal weight of the spleen (if it is not enlarged) is approximately 350 grams. In most cases, the enlarged spleen (splenomegaly) does not represent an independent clinical picture.

Rather, splenomegaly is considered a specific symptom of a variety of underlying diseases. For this reason, an enlarged spleen must always be perceived as a warning signal. In a healthy person, the spleen is normally not palpable under the left costal arch.

Only changes in organ structure ensure that the spleen becomes enlarged and palpable below the left costal arch. There are a number of reasons for the appearance of an enlarged spleen. Among the most common are diseases that lead to corresponding organ changes: The accompanying symptoms of an enlarged spleen depend on the extent of organ growth and the underlying disease.

For example, an enlarged spleen can put pressure on neighboring organs and thus lead to the occurrence of more pain. In addition, depending on the causative disease, an enlarged spleen is often accompanied by fever and/or joint pain. The most common causes of enlarged spleen include both acute and chronic inflammation.In addition, diseases of the haematopoietic system (for example leukemia) are among the most common triggers of spleen enlargement.

Furthermore, sarcomas (malignant tumors) or cysts (fluid-filled cavities) can lead to an enlarged spleen. Patients suffering from lymphatic or rheumatic underlying diseases also frequently develop splenomegaly during the course of the disease. In addition, all diseases that affect the breakdown of the blood affect the size of the spleen in most cases.

In this connection above all the so-called “Kugelzellanämie” plays a crucial role. In this disease, the defective form of the red blood cells (erythrocytes) causes increased blood breakdown within the spleen. In most cases, an enlarged spleen can be detected by palpation of the organ without a physical examination. Typical symptoms usually indicate the presence of an enlarged spleen. Among the most common of these symptoms are:

Infectious diseases (for example, Pfeiffer’s glandular fever)
Metabolic diseases
Tumors
Nausea
Feeling of fullness
Pain in the lower abdomen
Anemia
Pallor
Tiredness/weakness