Why is the spleen needed and why does it grow?
The spleen passes blood through itself, removes used red blood cells and platelets, retains microbes and stores a supply of blood cells. It increases when it is forced to work overload: with massive destruction of red blood cells, with a severe infection that requires an increased immune response, or with stagnation of blood if the flow from the portal vein is obstructed due to liver disease. Another group of reasons is the proliferation of tumor cells or the accumulation of altered cells directly in the organ tissue.
- Increased destruction of blood cells
- Response to infection
- Blood stasis in portal hypertension
- Tumor lesions in blood diseases
- Accumulation of substances in hereditary metabolic diseases
Main reasons
In adults, the most common cause in the world is liver disease with increased pressure in the portal vein system: cirrhosis, consequences of viral hepatitis. In second place are infections, from common mononucleosis in adolescents to malaria and tuberculosis. Blood diseases require special attention: lymphomas, leukemia, myeloproliferative diseases and hemolytic anemia, in which the spleen is very large. Less common are autoimmune diseases, splenic vein thrombosis and hereditary storage diseases.
- Liver cirrhosis and portal hypertension
- Viral hepatitis, infectious mononucleosis
- Malaria, brucellosis, tuberculosis, echinococcosis
- Leukemia, lymphoma, myelofibrosis
- Hemolytic anemia, thalassemia
- Systemic lupus erythematosus, rheumatoid arthritis
- Thrombosis of the splenic or portal vein
Symptoms and complications
A moderately enlarged spleen is usually not a concern. When the organ becomes large, it puts pressure on the stomach and diaphragm: there is a feeling of fullness after a few spoons of food, heaviness and dull pain in the left hypochondrium, sometimes radiating to the left shoulder. Due to the fact that the enlarged organ captures and destroys more blood cells, hypersplenism develops - a decrease in hemoglobin, leukocytes and platelets. The main danger is rupture due to injury: the capsule is stretched, and even a slight blow can cause internal bleeding.
- Heaviness and pain in the left hypochondrium
- Quick satiety during meals
- Weakness and pallor due to anemia
- Frequent infections with low white blood cells
- Bruising and bleeding with low platelets
- Risk of splenic rupture due to trauma
Survey
The doctor assesses the size of the spleen during examination, but confirms it with ultrasound - an accessible and accurate method. At the same time, the liver, portal vein and lymph nodes are examined. A complete blood count shows signs of hypersplenism and may indicate a blood disease, while liver tests and coagulation tests indicate liver damage. Further, the set of tests depends on the suspected cause: tests for hepatitis and HIV, tests for infections, rheumatological markers. If the picture is unclear, a CT scan and sometimes a bone marrow examination are performed.
- Ultrasound of the abdominal cavity with assessment of the liver and spleen
- General blood test with formula
- ALT, AST, bilirubin, albumin, coagulogram
- Tests for viral hepatitis and HIV
- Tests for infections according to the epidemiological situation
- CT or MRI of the abdomen
- Bone marrow examination for suspected blood disease
What to do and how to treat it
They treat not the spleen, but the cause: for hepatitis - antiviral drugs, for infection - appropriate treatment, for blood diseases - therapy prescribed by a hematologist. Often, after eliminating the cause, the organ gradually decreases in size. Removal of the spleen is discussed only in cases of severe hypersplenism, some hemolytic anemias, and in cases of rupture. After surgery, a person becomes vulnerable to severe infections, so they are vaccinated in advance. Anyone with an enlarged spleen is advised to avoid contact sports.
- Search and treatment of the underlying disease
- Avoiding contact sports and heavy lifting
- Caution when traveling and any abdominal trauma
- Avoiding alcohol for liver disease
- Removal of the spleen only for strict indications
- Vaccination before elective surgery
- Control ultrasound within the time prescribed by the doctor