Splenomegaly: Causes, Symptoms & Treatment

If a patient suffers from splenomegaly, his or her spleen is abnormally enlarged. Therapeutic steps usually address the underlying condition.

What is splenomegaly?

In medicine, the term splenomegaly describes an enlargement of the spleen. Depending on the person affected, splenomegaly may involve the weight or dimensions of the organ. In a healthy person, the spleen has an average weight of 350 grams with average dimensions of 4 centimeters in width and 11 centimeters in length. As a rule, splenomegaly is not considered a disease in its own right – rather, splenomegaly occurs as a symptom of various possible medical conditions. Symptoms of splenomegaly depend, among other things, on the extent of splenomegaly and the causative disease; for example, splenomegaly can exert pressure on neighboring organs and thus cause pain. In addition, depending on the causative disease, splenomegaly is often accompanied by fever or joint pain.

Causes

Possible causes of splenomegaly are varied. For example, infections of acute or chronic course, such as malaria, can result in splenomegaly. Various forms of leukemia (blood cancer) also lead to the development of splenomegaly in their course. In addition, sarcomas (malignant tumors) or cysts (tissue cavities filled with fluid) of the spleen can cause splenomegaly. Other underlying diseases that may promote splenomegaly include rheumatologic or lymphatic (affecting the lymphatic system) diseases. Anemia in the form of spleen cell anemia can also be associated with splenomegaly – spleen cell anemia is characterized primarily by an abnormally increased breakdown of red blood cells by the spleen. Finally, in the context of possible causes of splenomegaly that affect the spleen in an isolated manner, the organ’s bruises (hematomas) or hemangiomas (hemangiomas) are among others.

Symptoms, complaints, and signs

Enlargement of the spleen is accompanied by symptoms of the underlying disease in addition to those caused by the swelling itself. The large spleen causes a feeling of pressure under the left costal arch. Pain is also possible. When the organ is swollen to the point that the capsule surrounding it ruptures, there is extreme pain in the left upper abdomen that can radiate to the shoulder. In addition, there are complaints of the triggering underlying diseases. If there is an underlying infection, fever and general fatigue may occur. The lymph nodes are often swollen, and patients feel ill and dull. Cancers can also cause the spleen to swell, triggering a variety of symptoms depending on the site of origin. If the digestive tract is involved, diarrhea may occur. If the liver is involved, jaundice may occur, as well as fever, loss of appetite and weight loss. However, excessive appetite is also possible. If the trigger is a blood formation disorder, anemia and night sweats may occur. Patients have pale skin and feel powerless. Obstruction of the portal vein drainage can also lead to an enlarged spleen. If the cause is heart failure, this becomes apparent in shortness of breath, decreased performance, pulmonary edema or asthma. The undersupply of oxygen causes the skin and mucous membranes to turn bluish, edema to form on the legs, and fluid to collect in the abdomen.

Diagnosis and course

The first step in determining splenomegaly is usually a physical examination by the diagnosing physician – in contrast to a healthy spleen, an enlarged spleen in the context of splenomegaly can be palpated, for example. If a corresponding physical examination indicates the presence of splenomegaly, the exact extent of the splenomegaly can be determined, for example, with the aid of an ultrasound examination. Since splenomegaly is often associated with hyperplasia of the spleen or excessive depletion of blood cells, a patient’s blood count is usually checked with the help of a blood sample. Depending on the underlying disease behind splenomegaly, splenomegaly can have an acute (temporary) or chronic (long-term) course. In individual cases, the course of splenomegaly depends primarily on successful treatment of the underlying disease.

Complications

Splenomegaly can cause gastrointestinal distress, fatigue, and generalized weakness. Severe complications result if the disease is treated too late or inadequately. Consequential symptoms such as chronic pain, infections and visual changes may then occur. Externally, splenomegaly in advanced stages is manifested by pallor, blue fingers and conspicuous skin changes – aesthetic blemishes that can further worsen the patient’s psychological condition. Eventually, secondary diseases occur, which are associated with further discomfort. A typical complication of splenomegaly is hypersplenism, i.e. hyperfunction of the spleen. This can lead to cellular anemia and increase the tendency to bleed. When anemia occurs, the patient requires regular blood transfusions. If the spleen is removed, this has serious implications for the patient’s health. Although regular vaccinations reduce the risk of infection, the body is still more susceptible to illness. Some patients experience severe infections months or years after spleen removal, which may be life-threatening. Furthermore, thrombosis can occur in the weeks following the procedure. Prescribed medications can also cause side effects and interactions.

When should you see a doctor?

The affected person is dependent on medical examination and treatment by a physician for splenomegaly. Since this disease cannot heal on its own, early diagnosis is also very important in this case to prevent further complications. Therefore, a doctor should be consulted at the first signs of splenomegaly. The visit to the doctor is necessary when the affected person suffers from severe pain in the left side of the upper abdomen. In most cases, the pain occurs directly at the spleen. If this pain is permanent and, above all, occurs without any particular reason, a doctor must be consulted. In this case, symptoms such as diarrhea or fever may also indicate splenomegaly. Some affected individuals also exhibit a loss of appetite. If these symptoms occur, either an internist or a general practitioner can be consulted. Further examination and treatment depends strongly on the exact symptoms of splenomegaly and is carried out by a specialist. No general prediction can be made about the further course or life expectancy of the patient.

Treatment and therapy

Successful treatment of splenomegaly usually primarily addresses the individual causative underlying disease. If the disease that has caused splenomegaly can be successfully cured or controlled, this usually also has a positive effect on the splenomegaly present. However, the causes of splenomegaly cannot always be addressed medically, and in some cases an enlarged spleen results in further complications (such as progressive anemia). Therefore, in rare cases, surgical removal of the spleen (also known as splenectomy) may be medically necessary. Because the spleen performs immune defense tasks within the human body, among other functions, splenectomy is usually associated with an increased risk of infection. This risk relates primarily to infections caused by certain strains of bacteria. Patients with splenomegaly who are about to have their spleen removed are therefore given a vaccination a few weeks before the planned procedure to protect the organism against various pathogens. This protection against infection usually needs to be renewed at regular intervals after successful splenectomy.

Prevention

Because splenomegaly is often a consequence of an underlying disease, splenomegaly per se can be prevented only to a limited extent. However, early diagnostic and therapeutic steps regarding the causative disease can usually contribute to the regression of splenomegaly. If a complete regression of splenomegaly cannot be achieved with the aid of conservative therapeutic methods, further progression of splenomegaly can usually be prevented.

Follow-up

In cases of splenomegaly, the options for follow-up care are usually significantly limited. In some rare cases, they are not even available to affected individuals, so the patient’s first priority should be a rapid diagnosis so that there is also rapid and early treatment of this condition.Self-healing is usually not possible with splenomegaly, so that without treatment by a doctor, in the worst case scenario, the affected person may die. In most cases, the symptoms can be alleviated by taking various medications. In this case, the correct dosage and also a regular intake must always be observed, so that a correct treatment is achieved. If there are any uncertainties or questions, a doctor should be consulted first. Furthermore, the affected person should protect himself particularly well against various infections and diseases and not stay in high-risk areas. Vaccinations can also be very helpful and protect against such infections. It is possible that the splenomegaly limits the life expectancy of the affected person. However, the further course cannot be predicted in general.

What you can do yourself

In everyday life, the affected person can take care to positively stimulate his blood circulation. The consumption of foods that support a production of blood can be used specifically. The intake of nuts, pomegranates or legumes helps to support blood production. In parallel, the consumption of harmful substances such as alcohol and nicotine should be avoided. These lead to a deterioration of health and can cause an increase in symptoms. In case of fever, the daily consumption of fluids should be increased. The organism needs more nutrients during this time and should be supported through optimal hydration. Although there is a loss of appetite in addition to the symptoms of the disease, a sufficient amount of calories should be consumed daily. To gather new strength and support the body’s defense system, it is necessary to maintain a healthy and balanced diet. Often the cause of splenomegaly is due to cancer. Emotional strength is needed to cope with this disease. The physical discomfort is unusually high, and facing a reduced life expectancy can cause psychological distress. Therefore, relaxation techniques must be used so that coping with the disease is improved for the sufferer. The use of yoga or meditation by many sufferers found to be very helpful.