Splenectomy (Spleen Removal): Complications, Recovery, and More

A splenectomy is surgery to remove the entire spleen, a delicate, fist-sized organ that sits under the left rib cage near the stomach. The spleen is an important part of the body’s defense (immune) system. It contains special white blood cells that destroy bacteria and help the body fight infections when you are sick. It also helps remove, or filter, old red blood cells from the body’s circulation.

If only part of the spleen is removed, the procedure is called a partial splenectomy.

Unlike some other organs, like the liver, the spleen does not grow back (regenerate) after it is removed.

Up to 30% of people have a second spleen (called an accessory spleen). These are usually very small, but may grow and function when the main spleen is removed. Rarely, a piece of the spleen may break off with trauma, such as after a car accident. If the spleen is removed, this piece can grow and function.

Who Needs a Splenectomy?

You may need to have your spleen removed if you have an injury that damages the organ, causing its covering to break open, or rupture. A ruptured spleen can lead to life-threatening internal bleeding. Common injury-related causes of a ruptured spleen include car accidents and severe blows to the abdomen during contact sports, such as football or hockey.

A splenectomy may also be recommended if you have cancer involving the spleen or certain diseases that affect blood cells. Certain conditions can cause the spleen to swell, making the organ more fragile and susceptible to rupture. In some cases, an illness, such as sickle cell disease, can cause the spleen to shrivel up and stop functioning. This is called an auto-splenectomy.

The most common disease-related reason for a spleen removal is a blood disorder called idiopathic thrombocytopenic purpura (ITP). This is an autoimmune condition in which antibodies target blood platelets. Platelets are needed to help blood to clot, so a person with ITP is at risk for bleeding. The spleen is involved in making these antibodies and removing the platelets from the blood. Removing the spleen can be done to help treat the condition.

Other common reasons a person may need a spleen removal include:

Blood disorders:

• Hereditary elliptocytosis (ovalocytosis)
• Hereditary nonspherocytic hemolytic anemia
• Hereditary spherocytosis
• Thalassemia (Mediterranean anemia, or Thalassemia major)

Blood vessel problems:

Cancer:

• Leukemia, a blood cancer that affects cells that help the body fight infections.
• Certain types of lymphoma, a cancer that affects cells that help the body fight infections.

Other:

• Cyst or abscess (collection of pus) in the spleen

Before a Splenectomy

If your doctor thinks you have a ruptured spleen and you have signs of massive internal bleeding or unstable vital signs, such as low blood pressure, you will likely have spleen surgery right away.

In other cases, a complete physical exam, blood work, and tests to look at your abdominal and chest area will be done before surgery. The exact tests you have depend on your age and condition but may include a chest X-ray, electrocardiogram (EKG), magnetic resonance imaging (MRI) scan, and computed tomography (CT) scan.

You may need to follow a special liquid diet and take medication to clean out your bowels prior to the procedure. You should not eat or drink anything the morning of surgery. Your doctor will give you complete instructions.

Before surgery, you will be given drugs or a vaccine to prevent bacterial infections from developing after the spleen is removed.

How Is a Splenectomy Performed?

You will be given general anesthesia a few minutes before surgery so you are asleep and do not feel pain while the surgeon is working on you.

There are two ways to perform a splenectomy: laparoscopic surgery and open surgery.

Laparoscopic splenectomy is done using an instrument called a laparoscope. This is a slender tool with a light and camera on the end. The surgeon makes three or four small cuts in the abdomen, and inserts the laparoscope through one of them. This allows the doctor to look into the abdominal area and locate the spleen. Different medical instruments are passed through the other openings. One of them is used to deliver carbon dioxide gas into the abdominal area, which pushes nearby organs out of the way and gives your surgeon more room to work. The surgeon disconnects the spleen from surrounding structures and the body’s blood supply, and then removes it through the largest surgical opening. The surgical openings are closed using stitches or sutures.

Sometimes during laparoscopic splenectomy the doctor has to switch to the open procedure. This may happen if you have bleeding problems during the operation.

Open splenectomy requires a larger surgical cut than the laparoscopic method. The surgeon makes an incision across the middle or left side of your abdomen underneath the rib cage. After locating the spleen, the surgeon disconnects it from the pancreas and the body’s blood supply, and then removes it. The surgical openings are closed using stitches or sutures.

Laparoscopy vs. Open Surgery

Laparoscopy is less invasive than open surgery, and usually results in less pain, a faster recovery, and a shorter hospital stay. But not everyone can have laparoscopic surgery. Which method you and your doctor choose depends on your overall health and the size of your spleen. It can be hard to remove a very large or swollen spleen using a laparoscope. Patients who are obese or who have scar tissue in the spleen area from a previous operation also may not be able to have their spleen removed laparoscopically.

Recovering After a Splenectomy

After surgery, you will stay in the hospital for a while so doctors can monitor your condition. You will receive fluids through a vein, called an intravenous (IV) line, and pain medications to ease any discomfort.

How long you stay in the hospital depends on which type of splenectomy you have. If you have an open splenectomy, you may be sent home within one week. Those who have a laparoscopic splenectomy are usually sent home sooner.

It will take about four to six weeks to recover from the procedure. Your surgeon may tell you not to take a bath for a while after surgery so the wounds can heal. Showers may be OK. Your health care team will tell you if you need to temporarily avoid any other activities, such as driving.

Splenectomy Complications

You can live without a spleen. But because the spleen plays a crucial role in the body’s ability to fight off bacteria, living without the organ makes you more likely to develop infections, especially dangerous ones such as Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. These bacteria cause severe pneumonia, meningitis, and other serious infections. Vaccinations to cover these bacteria should ideally be given to patients about two weeks before planned surgery or roughly two weeks after emergency surgery. Your doctor may recommend other immunizations as well.

Infections after spleen removal usually develop quickly and make the person severely ill. They are referred to as overwhelming post-splenectomy infections, or OPSI. Such infections cause death in almost 50% of cases. Children under age 5 and people who have had their spleen removed in the last two years have the greatest chance for developing these life-threatening infections.

Other complications related to splenectomy include:

• Blood clot in the vein that carries blood to the liver
• Hernia at the incision site
• Infection at the incision site
• Inflammation of the pancreas (pancreatitis)
• Lung collapse
• Injury to the pancreas, stomach, and colon

Call the doctor right away if you have any of the following after a splenectomy:

• Bleeding
• Chills
• Cough or shortness of breath
• Difficulty eating or drinking
• Increased swelling of the abdomen
• Pain that doesn’t go away with prescribed medications
• Increasing redness, pain, or discharge (pus) at the incision site
• Nausea or vomiting that persists
• Fever over 101 degrees

Preventing Infections After Splenectomy

Children who have their spleen removed often need to take antibiotics every day to prevent them from developing bacterial infections. Adults usually do not need daily antibiotics, unless they become sick or there is a chance they could become sick. People who do not have a spleen who plan on traveling out of the country or to a place where medical help is not available should carry antibiotics to take as soon as they become sick. Also, if you have your spleen removed, ask your doctor about getting a flu shot each year.

What Causes an Enlarged Spleen?…

You may go your entire life and never even really think about your spleen. Unless it becomes damaged, your spleen will go on filtering your blood and producing white blood cells without a fuss. Tucked up under your rib cage, your spleen is well protected. This does not mean, however, that your spleen can’t become damaged, and potentially turn into a big problem. 

Enlarged Spleen (Splenomegaly) Definition and Facts

An enlarged spleen is the result of damage or trauma to the spleen from any of several different medical conditions, diseases, or types of physical trauma. Infections, liver problems, blood cancers, and metabolic disorders can all cause your spleen to become enlarged, a condition called splenomegaly.

When your spleen is enlarged, you are at an increased risk of it rupturing. A ruptured spleen or even a bad splenic laceration could cause massive amounts of internal bleeding, which will need immediate medical attention. 

What is the Spleen? What is its Function?

Your spleen is a small orange-sized organ in the upper left side of your abdominal cavity. Tucked behind the ninth, tenth, and eleventh ribs just under your left lung, your spleen is an organ that has a role to play in not just one, but two major systems of the body. 

The spleen is made of two distinct types of tissue, each with its own job. The first role of the spleen is to filter your blood. One kind of tissue in your spleen, known as the red pulp, helps remove damaged blood cells and other cellular waste materials from your blood supply. Your spleen is also responsible for holding platelets in reserve to aid in clotting when you are injured. The spleen also helps to maintain a healthy number of red blood cells in your blood to allow your blood to carry oxygen efficiently.

As a part of your lymphatic system, the second major function of the spleen is to help keep your immune system functioning properly. The second kind of tissue in your spleen, the white pulp, is responsible for helping to store lymphocytes. Also known as white blood cells, these cells are the main defense your body has against infections. When you are sick, the spleen releases these white blood cells into your bloodstream to attack any invaders, such as bacteria or viruses, in an attempt to destroy them and keep you healthy.

What Type of Pain Does an Enlarged Spleen Cause?

You would think any organ being enlarged would cause pain, but surprisingly, an enlarged spleen may not give you many signals that something is wrong.  

Unlike many other illnesses, problems with your spleen don’t often exhibit a lot of symptoms on their own. It takes a serious case of splenomegaly for you to begin feeling pain from your spleen. If your spleen becomes significantly enlarged, it is possible to experience pain in your upper abdomen and even into your left shoulder. 

The pressure an enlarged spleen can put on surrounding organs can sometimes be felt if the swelling has become severe enough. If you experience sharp pain in the upper left part of your abdomen when taking a deep breath, it may be time to talk to your doctor to see if you are suffering from splenomegaly. 

Causes of an Enlarged Spleen

With its role in cleaning and maintaining your blood supply, the spleen can be susceptible to many different conditions that affect your blood. This can include hereditary diseases and blood cancers like Hodgkin’s disease (a form of lymphoma) and leukemia. Your dietary habits and lifestyle could cause your spleen to become enlarged. Liver disease, such as cirrhosis caused by chronic alcoholism, can affect the spleen. Some forms of heart disease, which can be affected by diet and exercise, can also disrupt the blood supply to your spleen.

Blood disorders are a significant source of splenic problems. Since your spleen spends its day filtering and cleaning your blood supply, things that go wrong with your blood, particularly when they affect your red blood cells, can be a challenge for your spleen. Several of the blood disorders that are common causes of splenomegaly involve the spleen working too hard to remove damaged blood cells. These conditions include hemolytic anemia, sickle cell disease, thalassemia, and spherocytosis. 

The blood disorders mentioned above are not the only reason your spleen may be working overtime trying to target and filter damaged cells from your blood. Cancers such as leukemia and Hodgkin’s disease can both cause damage to blood cells and result in abnormal amounts of filtration by the spleen. It is also possible that other types of cancer can metastasize into splenic tissue. 

There are a number of metabolic and genetic disorders that can affect the spleen. These conditions are less focused on damage to the blood itself, but the damage to other tissues in the body can still cause there to be extra work for the spleen to do. The more common causes of this type of damage to the spleen include the following:

• Amyloidosis: the buildup of abnormal protein deposits in the spleen and other areas of the body
• Gaucher disease: a genetic enzyme deficiency disorder leading to damaged white blood cells
• Hurler Syndrome: a genetic condition preventing the proper digestion of sugar that affects many different organs, including the spleen 
• Niemann-Pick Disease: an enzyme deficiency allowing lipids to build up in several kinds of tissue throughout the body
• Sarcoidosis: a condition of the lymphatic system that causes inflammatory cells to build up in the spleen

Infections of various types are also possible causes of splenomegaly. This can include viral, bacterial, and even parasitic infections. These infections span the spectrum of serious, life-threatening infections from HIV/AIDS and malaria to tuberculosis and viral hepatitis. Other, lesser-known infections such as anaplasmosis and cytomegalovirus, can also cause damage to the immune system, including the spleen.

What are Other Signs and Symptoms of an Enlarged Spleen?

Most organs in the body have their way of telling you something is wrong. Chronic coughing and nasal drainage can indicate something has gone wrong in your respiratory system. Blood in your stool is a clear sign you should go talk to your doctor, as something might be very wrong in your digestive tract. Problems with your spleen, on the other hand, have few such telltale signs. 

If you find yourself pushing back from the table feeling full before you have eaten a full meal, a problem with your spleen is probably not the first thing that will come to mind. In fact, an unexplained sensation of fullness is sometimes an indication that your spleen has become enlarged and is pressing against your stomach. 

Other symptoms of splenomegaly are more closely related to whatever underlying ailments has damaged your spleen in the first place. These can run the gamut from the symptoms of infections like HIV/AIDS to liver disorders and malaria. A few common symptoms that are closely linked to splenic problems are listed below:

• Anemia
• Easy bleeding
• Fatigue
• Frequent infections
• Jaundice
• Pain in the upper left abdomen
• Weight loss

Treatments for Splenomegaly (or Enlarged Spleen)

It is unlikely you will ever go to the doctor just to investigate an enlarged spleen. Typically, the symptoms of the underlying cause of your splenomegaly will be the reason you seek medical attention. 

Diagnosing your condition will likely start with a physical exam and blood tests to see what is going on. If your doctor believes your spleen may be enlarged, he or she may recommend further imaging such as X-rays or a CT scan to get a better look at the condition of your spleen. 

From here, your course of treatment is going to depend on what causes of splenomegaly may have been identified. For some common causes it is possible that treatment through medication or lifestyle and diet changes can begin to bring about relief. For some other genetic conditions, cancers, or if your spleen has simply been too badly damaged, it may be necessary to remove your spleen altogether. 

The good news is, there is no reason to be concerned about having your spleen removed. There are many organs that you cannot live without, but the spleen is different. You can live a very full, normal life without a spleen, though there will be some negative effects. Due to the important role the spleen plays in maintaining your body’s reserve of white blood cells, having your spleen removed will make you more susceptible to infection for the rest of your life.  

Regardless of the reason for your splenomegaly, you should exercise caution if your spleen has become enlarged. The risk of splenic laceration or rupture is very real, especially if your spleen is enlarged. This is especially true of contact sports or outdoor action sports like skiing or mountain biking. 

Normally, your ribcage protects your spleen, but when it is damaged or irritated it is possible for your spleen to enlarge beyond the ribcage, making it easier to damage in an impact. This is why, as strange as it may seem, avoiding contact sports for a period of time after you have had certain illnesses like infectious mononucleosis is likely going to be something your doctor recommends. 

Whenever there is pain or discomfort in your abdomen for more than a few days, it may be time to talk to your doctor. This is particularly true if you are experiencing more worrying symptoms like unexplained bleeding or sharp pains when you breathe. If you are concerned you may be experiencing the symptoms of splenomegaly, or one of the serious conditions that can cause it, request an appointment at Cary Gastroenterology Associates today. We can help you sort through the symptoms and understand the risks and treatments available for an enlarged spleen. 

Bloated tummy and enlarged spleen: Hello all, I…

Bloated tummy and enlarged spleen

Hello all,

I have recently experienced a very bloated tummy and discomfort of the spleen. I am on W&W and my last ct scan revealed an enlarged spleen. I have no other symptoms. I am a bit worried. Is it common to have a bloated belly with an enlarged spleen? Mine was not bloated at all until recently. Could this mean that my spleen is getting bigger? Thank you in advance for your replies.

Have a lovely day,

Leila

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Leilalala

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A very large spleen can cause a bloated appearance and discomfort but I’m wondering if you’ve changed your diet significantly recently.

You were asking about EGCG and Curcumin recently, did you incorporate them into your diet? Has the bloating come on since then?

If your diet hasn’t changed too much you should talk to your CLL Dr about reassessing your spleen.

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Hello jm954…..my belly is also bloated and no longer soft…sounds like a drum when I tap on it and my spleen is moderately enlarged….all this started about a year ago. I mentioned the lump on the left side to several doctors and they all said it’s my depending colon. It was my primary care doctor who diagnosed me with spleenomegaly and sent me for a CT scan of the abdomen which shows my spleen to be11.9 cm x 17.3 cm. I will be discussing this with my hematologist April 9th at which time I will be having a lot of bloodwork drawn…..auto correct: desending. Ironically one of the individuals who examined me was my hematologist’s nurse practioner!

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Ovarian cancer can present like this and even though it’s unlikely, I’d still want it ruled out. It may have been excluded when you had your CT scan but worth asking and checking.

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Hi Leila,

A swollen stomach with an enlarged spleen isn’t that unusual and possibly more noticeable if you are not of such a large build. The important thing is you’ve had a CT scan which would have identified any stomach related issues but clearly didn’t. Sometimes it can be due to ascites which is a build up of fluid when the abdominal lymph nodes don’t drain efficiently. Jm is probably onto something with your dietary changes and I’m wondering if you’ve also increased your fibre intake which could be causing tummy/bowel problems.

I have quite an enlarged spleen and it also impacts in a number of ways mainly back pain and stomach irritation.

If it continues and you’re experiencing discomfort, mention it to your specialist. An ultrasound can be useful for identifying any problems without having to take another radiation hit.

Best wishes,

Newdawn

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Leilalala, when was the last scan you refer to?

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It’s possible because I have been dealing with the same thing for several months and look 3 months pregnant.

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Yes…I have been dealing with it for a year. ..my jeans don’t fit and my left side of my abdomen aches at times

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Splenomegaly – StatPearls – NCBI Bookshelf

Continuing Education Activity

Splenomegaly is defined as enlargement of the spleen measured by size or weight. The spleen plays a significant role in hematopoiesis and immunosurveillance. The major functions of the spleen include clearance of abnormal erythrocytes, removal of microorganisms and antigens as well as the synthesis of immunoglobulin G (IgG). The spleen also synthesizes the immune system peptides properdin and tuftsin. Approximately one-third of circulating platelets are stored in the spleen. The normal weight of the adult spleen is 70 g to 200 g, spleen weight of 400 g to 500 g indicates splenomegaly spleen weight greater than 1000 g is definitive of massive splenomegaly. This activity reviews the causes, evaluation, and management of splenomegaly and highlights the role of the interprofessional team in managing patients with this condition.

Objectives:

• Identify the etiology of splenomegaly.

• Describe the typical history and physical exam findings in a patient with splenomegaly.

• Outline the treatment and management options for splenomegaly.

• Review interprofessional team strategies for improving care coordination and communication to advance splenomegaly improve outcomes.

Access free multiple choice questions on this topic.

Introduction

Splenomegaly is defined as enlargement of the spleen measured by weight or size. The spleen plays a significant role in hematopoiesis and immunosurveillance. The major functions of the spleen include clearance of senescent and abnormal erythrocytes and their remnants, opsonized platelets and white blood cells and removal of microorganisms and antigens. The spleen also serves as a secondary lymphoid organ and is the site for maturation and storage of T and B lymphocytes, playing an important role in the synthesis of immunoglobulin G (IgG) by mature B-lymphocytes upon interaction with the T-lymphocytes.   The spleen also synthesizes the immune system peptides properdin and tuftsin. Approximately one-third of circulating platelets are stored in the spleen. The normal position of the spleen is within the peritoneal cavity in the left upper quadrant adjacent to ribs 9 through 12. The normal-sized spleen abuts the stomach, colon, and left kidney.

The size and weight of spleen may vary and correlates with weight, height, and sex of an individual, with larger spleen size seen in men compared to women, and in heavier or taller individuals. A normally sized spleen measures up to 12 cm in craniocaudal length.  A length of 12 cm to 20 cm indicates splenomegaly, and a length greater than 20 cm is definitive of massive splenomegaly. The normal weight of the adult spleen is 70 g to 200 g; a spleen weight of 400 g to 500 g indicates splenomegaly and spleen weight greater than 1000 g is definitive of massive splenomegaly. The normal-sized spleen is usually not palpable in adults. However, it may be palpable due to variations in body habitus and chest wall anatomy. Splenomegaly may be diagnosed clinically or radiographically using ultrasound, CT imaging, or MRI.  Splenomegaly may be a transient condition due to acute illness or may be due to serious underlying acute or chronic pathology.[1][2][3]

Etiology

There are several potential causes of splenomegaly. 

1. Liver disease (cirrhosis, hepatitis): Parenchymal liver disease causes increased vascular pressure leading to an increase in spleen size.

2. Hematologic malignancies (lymphomas, leukemias, myeloproliferative disorders): Neoplastic cells cause infiltration of the spleen leading to splenomegaly.

3. Venous thrombosis (portal or hepatic vein thrombosis): This leads to an increase in vascular pressure leading to splenomegaly.

4. Splenic congestion (venous thrombosis, portal hypertension, congestive heart failure).

5. Cytopenias (Immune thrombocytopenic purpura, autoimmune hemolytic anemia, immune-mediated neutropenia, Felty syndrome): Immune-mediated destruction of red blood cells, white blood cells or platelets lead to functional splenomegaly.

6. Splenic sequestration (pediatric sickle cell disease, hemolytic anemias, thalassemias).

7. Acute or chronic infection (bacterial endocarditis, infectious mononucleosis, HIV, malaria, tuberculosis, histiocytosis, abscess).

8. Connective tissue diseases (systemic lupus erythematosus, rheumatoid arthritis, Adult-onset Still’s disease, and some familial autoinflammatory syndromes).[4][5]

9. Infiltrative disorders (sarcoidosis, amyloidosis, glycogen storage diseases).

10. Splenic sequestration (pediatric sickle cell, hemolytic anemias, thalassemias).

11. Focal lesions (hemangiomas, abscess, cysts, metastasis).

The mechanism underlying splenic enlargement varies based on the etiology. In the case of acute infectious illness, the spleen performs increased work in clearing antigens and producing antibodies and increases the number of reticuloendothelial cells contained within the spleen. These increased immune functions may result in splenic hyperplasia. In the case of liver disease and congestion, underlying illness causes increased venous pressure causing congestive splenomegaly. Extramedullary hematopoiesis exhibited in myeloproliferative disorders can lead to splenic enlargement (infiltrative splenomegaly).[6][7]

Splenic sequestration crisis (SSC) is a life-threatening illness common in pediatric patients with homozygous sickle cell disease and beta-thalassemia. Up to 30% of these children may develop SSC with a mortality rate of up to 15%. This crisis occurs when splenic vaso-occlusion causes a large percentage of total blood volume to become trapped within the spleen. Clinical signs include a severe, rapid drop in hemoglobin leading to hypovolemic shock and death. Pediatric patients with sickle cell disease and beta-thalassemia experience multiple splenic infarcts, resulting in splenic fibrosis and scarring. Over time, this leads to a small, auto infarcted spleen typically by the time patients reach adulthood. Splenic sequestration crisis can only occur in functioning spleens which may be why this crisis is rarely seen in adults. However, late adolescent or adult patients in this group who maintain splenic function may also develop the splenic sequestration crisis.

Epidemiology

Splenomegaly is a rare condition, with an estimated prevalence of approximately 2% of the total United States population. In adults, there has been no reported predominance in prevalence based on ethnicity, gender, or age. In Asia and Africa, tropical splenomegaly is very common. In older people, the capsule of the spleen is thin, thus the risk of rupture is higher.

Pathophysiology

Splenomegaly can be classified based on its pathophysiologic mechanism: 

• Congestive, by pooled blood (e.g., portal hypertension)

• Infiltrative, by invasion by cells foreign to the splenic environment (e.g., metastases, myeloid neoplasms, lipid storage diseases)

• Immune, by an increase in immunologic activity and subsequent hyperplasia (e.g., endocarditis, sarcoidosis, rheumatoid arthritis)

• Neoplastic, when resident immune cells originate a neoplasm (e. g., lymphoma).

History and Physical

The most common physical symptom associated with splenomegaly is vague abdominal discomfort. Patients may complain of pain in the left upper abdomen or referred pain in the left shoulder. Abdominal bloating, distended abdomen, anorexia, and/or early satiety may also occur. More commonly, patients will present with symptoms due to the underlying illness causing splenomegaly. Constitutional symptoms such as weakness, weight loss, and night sweats suggest malignant illness. Patients with splenomegaly due to acute infection may present with fever, rigors, generalized malaise, or focal infectious symptoms. Patients with underlying liver disease may present with symptoms related to cirrhosis or hepatitis. Symptoms of anemia (lightheadedness, dyspnea, or exertion), easy bruising, bleeding, or petechiae may indicate splenomegaly due to the underlying hemolytic process.

Physical examination of the spleen is performed with the patient in supine and right lateral decubitus position with neck, hips, and knees flexed. This positioning relaxes abdominal wall musculature and rotates the spleen more anteriorly. Light fingertip pressure is applied below the left costal margin during deep inspiration. The examiner may feel the rounded edge of the spleen pass underneath the fingertips at maximum inspiration. The exam is abnormal if the spleen is palpated more than 2 cm below the costal margin. In massive splenomegaly, the spleen may be palpated deep into the abdomen, crossing the midline of the abdomen and may even extend into the pelvis. Studies have shown that normal sized spleens may be palpable in approximately 3% of adults.

Patients may have an abnormally palpable spleen with or without exam findings of contributing underlying illness. Patients with splenomegaly due to acute infection may have exam findings consistent with infectious mononucleosis, endocarditis, or malaria. Exam findings of petechiae, abnormal mucosal bleeding, or pallor may accompany hematologic diseases. Jaundice, hepatomegaly, ascites, or spider angiomata may be present in patients with liver disease.  Patients with rheumatologic diseases may present with joint tenderness, swelling, rash, or an abnormal lung exam.

Evaluation

A combination of serum testing and imaging studies may definitively diagnose splenomegaly and the underlying cause. Derangement in the complete blood (cell) counts and morphology including WBC, RBC, and platelets will vary based on the underlying disease state. Abnormalities in liver function tests, lipase, rheumatologic panels, and disease-specific infectious testing aid in the diagnosis of causative disease.[8] Hypersplenism may present with leukopenia, anemia, and thrombocytopenia.

Imaging may be used to diagnose splenomegaly and elucidate its underlying cause. The spleen has a similar attenuation as the liver when measured on CT imaging. In addition to diagnosing splenomegaly (a splenic measurement of greater than 10 cm in craniocaudal length), abdominal CT may detect splenic abscess, mass lesions, vascular abnormalities, cysts, inflammatory changes, traumatic injury, intra-abdominal lymphadenopathy, or liver abnormalities.

Ultrasound is a useful imaging modality in measuring the spleen and spares the patient radiation from CT imaging. Normal spleen size measured via ultrasound is less than 13 cm superior to the inferior axis, 6 cm to 7 cm in medial to lateral axis and 5 cm to 6 cm in anterior to the posterior plane.

MRI, PET scans, liver-spleen colloid scanning, and splenectomy and splenic biopsy may be indicated in certain cases.

Treatment / Management

Treatment of splenomegaly is targeted at treating the underlying disease and protecting the patient from complications of splenomegaly itself.  Patients with splenomegaly from any cause are at increased risk of splenic rupture, and increased attention must be made to protect the patient from abdominal trauma. Treatment ranges from abdominal injury avoidance in the young healthy patient with splenomegaly due to infectious mononucleosis, to splenectomy of a massively enlarged spleen in a patient with hairy cell leukemia. Likewise, the prognosis is largely dependent on the underlying disease state. [9][10]

Splenic sequestration is seen in sickle cell anemia is often managed with blood transfusions/exchange transfusions. Sometimes splenectomy is required for ITP. Low dose radiation therapy can also shrink the spleen size in patients with primary myelofibrosis.

Patients who undergo splenectomy are at increased risk of infections secondary to encapsulated organisms such as Haemophilus Influenzae, Streptococcus pneumoniae, and Neisseria meningitidis. Vaccinations against these organisms are highly recommended in patients who have undergone splenectomy. Careful attention must be paid to post-splenectomy patients presenting with febrile illnesses as they may require more aggressive, empiric antibiotic therapy.

Differential Diagnosis

There are several potential causes of splenomegaly, and careful and thorough evaluation is often needed to find the underlying cause of splenomegaly.

These include:

Liver disease (cirrhosis, hepatitis) is one of the most common causes and history of liver disease, abnormal physical exam findings and elevated liver enzymes in addition to abnormal liver imaging can help diagnose liver diseases.

Hematologic malignancies and metastasis shall be especially considered in patients with constitutional symptoms and weight loss. Abnormal peripheral blood smear and biopsy can assist in diagnosing malignancies.

Autoimmune diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) frequently are associates with splenomegaly. In RA, the presence of splenomegaly in addition to neutropenia is termed Felty syndrome. 

Acute and chronic infections including viral, bacterial, fungal, and mycobacterial infections can all cause splenomegaly and shall be carefully ruled out.

Cytopenias and diseases causing splenic sequestration can be ruled out by complete blood counts, peripheral blood smear and hemoglobin electrophoresis.

Infiltrative disorders such as glycogen storage diseases are a rare cause of splenomegaly and shall be considered if other more common causes are ruled out in patients with other clinical features consistent with these glycogen storage diseases.

Prognosis

The prognosis for patients with splenomegaly depends on the condition causing the enlargement. Regardless of the underlying etiology, the risk of rupture even with minor trauma is high in patients with an enlarged spleen.

Complications

Splenic rupture is the most feared complication of splenomegaly. Patients are advised to avoid high-impact or contact sports to minimize this risk. Cytopenias due to splenomegaly is another potential complication. Most of these can be minimized with splenectomy if indicated. 

Deterrence and Patient Education

Patients with enlarged spleens are advised to avoid high-impact or contact sports to avoid the risk of splenic rupture. 

Once a patient undergoes splenectomy, they should be advised of the higher risk of infections and proper immunization should take place to minimize this risk. 

Enhancing Healthcare Team Outcomes

Patients with splenomegaly are best managed by an interprofessional team that includes a radiologist, internist, hematologist, oncologist, surgeon, nursing staff and sometimes other specialists such as rheumatologists and gastroenterologists. Due to a high risk of rupture, patient education is crucial, and contact sports shall be avoided in patients with splenomegaly. 

The nursing staff should educate the patient on the risk of infections if they undergo splenectomy. Vaccination against encapsulated organisms is highly recommended prior to the splenectomy.  All patients who have had a splenectomy should wear a medical alert bracelet explaining the absence of a spleen. Antibiotic prophylaxis is recommended in post-splenectomy patients undergoing surgical procedures. Further, careful attention must be paid to post-splenectomy patients presenting with febrile illnesses as they may require more aggressive, empiric antibiotic therapy.

All patients with splenomegaly should be educated about the signs of splenic rupture and when to seek medical assistance. Unlike a normal spleen, an enlarged spleen that has ruptured cannot be managed with observation. Close collaboration with the team members is important to ensure that patients without a spleen have good outcomes.  Most patients have a good outcome after splenectomy.[11][12]

Figure

Radiograph Abdomen Splenomegaly. Contributed by Scott Dulebohn, MD

Figure

CT Splenomegaly. Image courtesy O.Chaigasame

References

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Nguyen Y, Stirnemann J, Belmatoug N. [Gaucher disease: A review]. Rev Med Interne. 2019 May;40(5):313-322. [PubMed: 30638965]

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Kang DW, Kim SH. Clinical aspects of splenomegaly as a possible predictive factor of coronary artery changes in Kawasaki disease. Cardiol Young. 2018 Dec 21;:1-6. [PubMed: 30572971]

3.

Gala AR, Surapaneni T, Aziz N, Kallur SD. A Review of Outcomes in Pregnant Women with Portal Hypertension. J Obstet Gynaecol India. 2018 Dec;68(6):447-451. [PMC free article: PMC6207547] [PubMed: 30416270]

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Justiz Vaillant AA, Goyal A, Bansal P, Varacallo M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Dec 30, 2020. Systemic Lupus Erythematosus. [PubMed: 30571026]

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Chauhan K, Jandu JS, Goyal A, Bansal P, Al-Dhahir MA. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jun 29, 2021. Rheumatoid Arthritis. [PubMed: 28723028]

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Palmiere C, Tettamanti C, Scarpelli MP, Tse R. The forensic spleen: Morphological, radiological, and toxicological investigations. Forensic Sci Int. 2018 Oct;291:94-99. [PubMed: 30173072]

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Sjoberg BP, Menias CO, Lubner MG, Mellnick VM, Pickhardt PJ. Splenomegaly: A Combined Clinical and Radiologic Approach to the Differential Diagnosis. Gastroenterol Clin North Am. 2018 Sep;47(3):643-666. [PubMed: 30115442]

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Allison J, Sunne R, Huntington M. Multifactorial Splenomegaly. S D Med. 2017 Dec;70(12):535-538. [PubMed: 29334440]

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Saab S, Brown RS. Management of Thrombocytopenia in Patients with Chronic Liver Disease. Dig Dis Sci. 2019 Oct;64(10):2757-2768. [PubMed: 31011942]

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Kado R, McCune WJ. Treatment of primary and secondary immune thrombocytopenia. Curr Opin Rheumatol. 2019 May;31(3):213-222. [PubMed: 30920453]

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Vittorio J, Orellana K, Martinez M, Ovchinsky N, Schlossberg P, Griesemer A, Lobritto S. Partial Splenic Embolization Is a Safe and Effective Alternative in the Management of Portal Hypertension in Children. J Pediatr Gastroenterol Nutr. 2019 Jun;68(6):793-798. [PubMed: 30908386]

12.

Ashorobi D, Fernandez R. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): May 27, 2021. Asplenia. [PubMed: 30844198]

What are the Symptoms and Signs of Liver Cancer?

In its early stages, liver cancer may not show any apparent signs and symptoms. Over time, though, as a tumor in the liver grows, a patient may see or feel it. Or a doctor may see or feel it during a checkup. At this point, the cancer may be advanced and more difficult to treat.

Primary liver cancer (cancer that starts in the liver) and secondary liver cancer (cancer that begins elsewhere and spreads to the liver) cause the same symptoms.

Early warning signs of liver cancer

The symptoms of liver cancer may differ for each person, and any one of these symptoms may be caused by other conditions. Also, while it’s true that liver cancer symptoms are more common in the later stages, some patients develop them earlier.

Some common early warning signs of liver cancer include:

• Pain in the upper abdomen on the right side or near the right shoulder blade
• Abdominal swelling (ascites) or bloating in the abdomen that develops as a mass
• Enlarged liver (hepatomegaly) felt as a mass under the ribs on the right side
  Jaundice (yellowing of the skin and eyes)

Other signs and symptoms of liver cancer include:

• Fever
• Dark urine
• Pale/chalky stools
• Easy bruising or bleeding 
• Fatigue
• Weakness
• Unexplained and unintentional weight loss
• Poor appetite
• Enlarged spleen felt as a mass under the ribs on the left side
• Feeling of fullness after eating a small amount of food
• Nausea
• Vomiting

Many of these symptoms may be caused by other types of benign liver infections or diseases. In the case of liver cancer, the symptoms may continue to evolve and worsen as the tumor grows and the disease advances. If the patient notices potential symptoms, it’s important to see a doctor for an accurate diagnosis.

Paraneoplastic syndromes

In rare cases, other disorders may develop as a result of liver cancer, especially in the early stages of the disease. Paraneoplastic syndromes cause symptoms in other parts of the body. Awareness of these symptoms may help with diagnosing liver cancer. Some paraneoplastic syndromes related to liver cancer include:

• Hypercalcemia (high blood calcium levels)
• Hypoglycemia (low blood sugar levels)
• Erythrocytosis (high red blood cell count)
• Hypercholesterolemia (high cholesterol levels)
• Gynecomastia (breast enlargement)
• Shrinking of testicles in men

Cancer screening and risk factors

Based on symptoms alone, it may be difficult to detect liver cancer early, when it’s often easier to treat. For some people who have a higher risk of developing liver cancer, screening may be recommended or beneficial. If you have one or more risk factors for liver cancer, connect with your care team to discuss screening options.

Pain: part 3 – Abdominal discomfort

For many people, abdominal discomfort is perhaps an inevitable consequence of the excessive amounts of chocolate consumed on Easter Sunday. However, on a serious note, continued abdominal distress presenting as either a sharp pain or a constant sense of “fullness” in the belly, can sometimes be a sign of leukaemia. In fact, 11% of patients are thought to experience abdominal discomfort or a “swollen stomach” as a symptom prior to their diagnosis.

Cause of abdominal pain in leukaemia

In most cases, the cause of an abdominal discomfort in leukaemia is an enlarged spleen (splenomegaly). This can occur when leukaemia cells begin to accumulate in and around the spleen causing it to swell. In rarer cases, the abdominal pain can also be caused by an enlarged liver (hepatomegaly).

The spleen is an organ (about the size of a fist) on the upper left side of the body, just beneath the ribs. It acts like a filter to remove infectious germs and damaged red blood cells from the blood. The spleen also controls how many white blood cells, red blood cells and platelets (cells that make blood clot) our body produces.

Normally you cannot feel your spleen; however, when it enlarges to a certain size, it can be felt by you or your doctor. This is referred to as a palpable spleen.

“I had a swollen spleen, which felt like laying on a tennis ball when in bed.”

Abdominal discomfort in children

An enlarged spleen is a key presenting symptom of leukaemia in children. As many as 50% of children with acute leukaemia develop splenomegaly and most infants with a very rare form of childhood leukaemia, juvenile myelomonocytic leukaemia (JMML), will show signs of an enlarged spleen. Children may complain of a stomach ache, show signs of a lack of appetite, or a loss of weight. Other key symptoms to look out for in children are complaints of pain in the legs and bruising.

Spotting abdominal pain

An enlarged spleen doesn’t always cause discomfort. For this reason, the condition is commonly detected during a visit to the doctors. You may not be aware of the spleen swelling, and sometimes a partner may be the first to notice something is wrong.

“I also had pain in my lower back, which I thought was from overdoing things, and swelling on the left-hand side of my abdomen (I couldn’t see it myself, but it was very noticeable to others).”

However, it is also important to look out for the following symptoms:

• Decreased appetite
• You may start to feel full after eating very little food (an enlarged spleen can press upon the stomach, giving your brain a false sensation of “fullness”).

“I lost my appetite and generally started to feel unwell.”

• Weight loss
• A gradual loss of appetite will also mean you start to lose weight if you are eating less than usual.
• Weight loss may also be a direct result of the leukaemia cells. Rapidly dividing leukaemia cells use up energy that your body would otherwise use or store.

“I also noticed a change in my weight and I lost my appetite. I later learned that this was caused by my enlarged spleen which was pressing on my stomach.”

• Feeling of discomfort or pain behind your left ribs 
• If part of the spleen is damaged this may occur as a sharp shooting pain in the left of the abdomen. Otherwise, this might be an ache or general discomfort on the left side.
• Enlargement of the spleen can mean it loses its ability to function properly. It might start to filter out healthy blood cells from the body instead of just the abnormal ones. This can result in:
• Anaemia due to a loss of healthy red blood cells.
• Increased risk of bleeding or bruising due to a reduction of platelets.
• Increased frequency of infections due to a lack of healthy white blood cells.

When should I be concerned?

Any persistent abdominal pain is worth visiting your GP about. With so many organs in the abdomen, there are many different problems that can manifest in abdominal discomfort, including appendicitis, gallstones, ulcers, infections and problems of the GI tract. A doctor will be able to decipher the root cause by using blood tests, an ultrasound, or computerized tomography (CT) scan.

It is important to see a doctor straight away if your abdominal discomfort is affecting your ability to function or if you are experiencing any other symptoms such as loss of appetite, weight loss, fever, nausea, or any seemingly unrelated symptoms such as blurred vision, mouth ulcers or increased bruising and bleeding.

Dog Enlarged Spleen – Enlarged Spleen Treatments for Dogs

Splenomegaly in Dogs

Splenomegaly refers to the enlargement of the spleen. This medical condition can occur in all breeds and genders, but middle-aged dogs and larger breeds tend to be more prone. It is also not usually directly related to the spleen, but rather a symptom of another disease or condition. Treatment options will be recommended based upon the cause of the splenomegaly.

Symptoms and Types  

An enlarged spleen may lead to such symptoms as:

• Diarrhea
• Vomiting
• Lack of appetite
• Abdominal pain
• Lethargy and reduced activity
• Weakness and even collapse

Causes  

A variety of things are known to cause an enlarged spleen including an abdominal injury, canine hepatitis, infectious disorders, inflammatory bowel disease, bacterial infection, cell tumors of the spleen, and other immune disorders. While these are some of the most common causes, the medical causes for an enlarged spleen are not directly related to the spleen itself, but rather a symptom of another disease or condition.

Diagnosis

Upon examination, a prominent spleen or a protruding abdomen may be noticed. A fine needle aspiration may then be used to diagnose the spleen disorder. Also, ultrasounds and X-rays may be used to view the spleen and surrounding areas for abnormalities. In addition to imaging, blood work will give a comprehensive review of all possible underlying medical issues.

Treatment

The recommended treatment options will be dependent upon the underlying causes of the enlarged spleen. As an enlarged spleen is typically a sign of another underlying medical condition, it is important to understand the cause before establishing a proper treatment for the animal. In severe cases, removal of the spleen (splenectomy) may be recommended.

Living and Management

Many of the common underlying medical causes are treatable with prescription medication. In the event that the spleen is removed, Your dog will require rehabilitation to heal properly; its activity should also be restricted.

Prevention

There are currently no known preventative measures for an enlarged spleen.

90,000 Splenomegaly or enlarged spleen | Infomedic.ru

SPLENOMEGALIA

This is the name in medicine for an enlarged spleen or swelling of the spleen, as well as chronic enlargement of the spleen, which, among other complaints, causes abdominal pain, nausea, vomiting and bloating. Splenomegaly is not an independent disease, it is the result of various diseases – in most cases of infectious diseases (for example, glandular fever or blood diseases (for example, leukemia or Hodgkin’s disease), in addition, splenomegaly can appear, with rheumatic diseases, or septicemia (sepsis).

Spleen

The spleen (from Latin “lien”, Greek “spleen”) has a size of 11 × 7 × 4 cm and weighs 150-200 g, it belongs to the so-called “lymphatic system” and is located in the upper left abdomen, more precisely below diaphragm and above the left kidney. The bean-shaped organ is surrounded by a dense capsule of connective tissue that protects the splenic tissue itself, the spleen pulp, and has three main tasks: on the one hand, it produces certain white blood cells (the so-called B and T lymphocytes) to protect against external stimuli …On the other hand, it serves to filter and remove red blood cells, and as a storage site for white blood cells and platelets (monocytes). The different functions of the spleen differ in color: for example, the area responsible for the immune defense appears white (white pulp), the blood filter in the spleen, on the other hand, is dark red (red pulp).

Splenomegaly is an acute or chronic enlargement of the spleen, i.e., exceeding the normal weight of an organ of 350 g and a length of 11 cm.Image: pixdesign123 / stock.adobe.com

Actually next to the spleen itself, 10% of people have one or more so-called “splenic nerves” (splenic accessory nerve), which look like small nodules in an organ and consist of spleen tissue. Their structure and functions are identical and they are located mainly near the gate of the spleen. If the spleen must be surgically removed due to disease, then these auxiliary splenic nerves must also be removed – since without the complete removal of the entire spleen, the disease cannot be completely cured.

Before the baby is born, the spleen is a vital organ, since it is significantly involved in the formation of white blood cells and (somewhat less) red ones. For adults, however, it is not vital, as its functions can be performed by the liver, bone marrow and other lymphatic organs. Accordingly, removal of the spleen (for example, as a result of severe bleeding), as a rule, does not bring serious complications, the only thing is that patients more often than others note an increased susceptibility to infections.

Determination of enlarged spleen

An enlarged spleen (splenomegaly) is an acute or chronic enlargement of the spleen, that is, exceeding the normal weight of an organ of 350g or length (normal indicators: length 11cm, width 7cm, thickness 4cm). To accurately determine the magnitude of splenomegaly, there are three stages: in the first – mild stage, the weight of the organ is 300-500 g, with moderate splenomegaly between 500 and 800 g, and with massive splenomegaly more than 1000 g.

Symptoms

In most cases, a swollen or enlarged spleen causes few complaints.However, if the spleen is so large that it presses on the stomach or other organs in the abdominal cavity, then there is a feeling of fullness, general malaise or nausea and vomiting, and some pressure problems while eating. In addition, pain occurs as a result of an enlarged organ, in part in the form of abdominal pain and / or back pain in the spleen area, in some patients the pain also extends to the left shoulder, chest or back.

Most often, the symptoms of the disease underlying the enlargement of the spleen are manifested primarily in the form of: the appearance of fever, painful swelling of the lymph nodes in the neck (with glandular fever) or joint pain (with rheumatic diseases).

In addition, an enlarged spleen may. lead to excessive stagnation of blood cells, resulting in pallor, fatigue, weakness, or rapid heartbeat. A lack of white blood cells, in this context, often means a higher susceptibility to infectious diseases, in the case of low blood platelets, patients, for example, may have more nosebleeds.

Causes of enlarged spleen

In most cases, splenomegaly is a consequence of other diseases or infections, rarely occurs a disease that refers only to the spleen itself.Often the organ is affected by diseases of the blood or lymphatic system, such as leukemia or Hodgkin’s disease, a malignant tumor of the lymphatic system.

In addition to enlargement of the spleen, infectious diseases such as tuberculosis, malaria, or glandular fever often appear in parallel. Blood poisoning (sepsis) is also considered to be a cause of enlarged spleen, when the infection spreads in the body uncontrollably it can become life-threatening and therefore must be treated quickly.

Also, rheumatic diseases such as lupus erythematosus or the so-called “lysosomal disease” can cause splenomegaly, that is, disorders in which the storage of metabolic products occurs in tissues and organs that change as a result of pathology (for example, Gaucher disease).

In addition, stagnant blood in the liver can be a causative agent if blood stagnates from the back of the gastrointestinal tract to the spleen, instead of draining to the liver.Such stagnation of blood can be the result of a number of diseases, for example, cirrhosis of the liver or inflammation of the pancreas (pancreatitis) and liver (hepatitis). Also, tumors or cysts can cause an enlargement of the organ.

In addition, anemia (anemia) may be accompanied by an enlarged spleen. Characteristic of this most common hemolytic anemia in central Europe is the painfully increased degradation of red blood cells due to the spleen. Bruises (hematomas) or hemangiomas (hemangiomas) of an organ may be considered as a cause of splenomegaly affecting the spleen.

Diagnosis

At the first stage, the doctor usually conducts a physical examination to detect splenomegaly, since, unlike a healthy spleen, an enlarged spleen can be found on the left under the arch of the rib when the patient is breathing deeply.

Ultrasound (sonography) and other imaging techniques such as computed tomography can provide information about the size of the spleen and the reasons for the enlargement.

Ultrasound examination helps to examine the condition of the spleen and establish changes in its size.Image: Klaus Eppele / stock.adobe.com

In addition, in most cases a blood test is done – the size and shape of the blood cells show the cause of splenomegaly, bone marrow examination can also reveal blood cancers such as leukemia or lymphoma, or the accumulation of unwanted substances (lysosomal disease). By measuring the protein content in the blood, diseases such as malaria and tuberculosis can also be ruled out.

Another way to detect splenomegaly or hyperfunction of the spleen is the so-called “scintigraphy” – a medical diagnostic imaging method in which blood cells are stained with a special substance and thus can be distinguished.

Therapy and treatment

Treatment for splenomegaly usually depends on the underlying disorder. If it can be successfully treated or brought under control, then as a consequence, there is a positive effect on the spleen. However, sometimes treatment of the underlying disease does not give results or complications appear (for example, with anemia or platelet deficiency). Surgical removal of the spleen (splenectomy) is rarely done. Such intervention can be performed, for example, in the event of a ruptured spleen as a result of a major accident.The operative approach is very diverse – thus, it is possible to completely remove the spleen (complete splenectomy) or only partially (subtotal splenectomy). Today, these operations are minimally invasive, however, depending on the underlying disease or the size of the spleen, open surgery can be performed.

Since the spleen in the human body plays an important role in immune defense, surgical removal of an organ usually results in an increased risk of contracting infections (for example, pneumococcal, meningococcal and hemophilic infections) and various forms of pneumonia.Vaccination of the most common encapsulated bacteria is an important and very effective preventive measure for patients after spleen removal. With planned interventions, the patient is vaccinated 2-3 weeks before the operation, and the vaccination must be repeated every 5-10 years, since infections with these bacteria after splenectomy can cause serious illness. Children and adolescents, whose immune systems are significantly weaker than in adults, are at higher risk of contracting infections – therefore, surgical removal of the spleen, if possible, should only be performed at the age of 6 years.

An alternative method for relieving discomfort from severely swollen spleen is whole-organ radiation therapy with extremely low doses of radiation (0.2 g).

Treatment in naturopathy

Naturopathic remedies are often used for a variety of functions of the spleen and act as a useful and effective supplement or alternative to traditional medicine. For complaints about the spleen, in addition to direct treatment, nutrition is often recommended, which regulates the acid-base balance in the body.It should be balanced and contain foods that have not been cooked.

While spleen specific nutrition does not play any role in local medicine, it plays a large role in traditional Chinese medicine and is aimed at strengthening the spleen. The task of nutrition is to extract energy from food and provide it to the organ. In this regard, in Chinese medicine, it is recommended to eat slightly sweet and bitter foods, from vegetables (for example, dill), fruits and herbs (coriander, cloves), sweet foods should be chewed well, since only with this approach, carbohydrates are quickly converted into sugar.In addition, hot meals are good for the spleen, which is why the Chinese recommend cooked whole grains of wheat, oats, barley, rice, millet, corn, and chestnuts. In addition, they consume legumes and nuts, lean meat of chicken, pheasant or sheep, several types of fish, as well as various spices (for example, cloves, star anise, nutmeg and cinnamon).

With an enlarged spleen, patients take orally tinctures and teas with pollen. Image: pixabay.com

In the west, herbal medicine (herbal medicine) is often presented only in the form of individual medicinal plants.In the case of an enlarged spleen, chopped grindelia and scolopendurium (deer fern) and bitter plants such as calamus, gentian, ginger, dandelion or wormwood are taken.

Medicinal plants can usually be used as tea or even in the form of medications, as well as homeopathic remedies; in the field of homeopathy, Zeanotus Americanus is also often used.

In any case, no matter what form of treatment is chosen, you should first consult a specialized doctor in order to rule out serious illness or injury that may lead to surgery.In addition, each form of alternative medicine must be studied and agreed with the attending physician in order to be able to develop the best therapy and eliminate the risks.

Show sources

Author:

Sergey Nikolaevich Melnikov

Sources:

• Great Medical Encyclopedia, www.med-edu.ru
• Splenomegaly. Gastrointestinal tract. 2014; 01: 6 Portal Consilium Medicum, www.con-med.ru
• Henry P., Longo D .: INCREASING LYMPHONIC NODES AND Spleen. Harrison’s Principles of Internal Medicine. 14-th edition, 2002

Document

Signs and Symptoms

Type 1 Gaucher disease is usually characterized by rapid progression. This disease can lead to
severe or disabling symptoms, which are sometimes irreversible.Disease progression can vary widely and be unpredictable.

The most common symptoms of Gaucher disease are as follows: splenomegaly, hepatomegaly, anemia, thrombocytopenia,
damage to the bones. These signs and symptoms are described below.
Skeletal involvement associated with bone marrow infiltration is typical of Gaucher disease and may be
extremely painful and debilitating. Up to 83% of patients have clinical or radiographic
evidence of bone lesions, and 34% of patients suffer from bone pain at the time of diagnosis.Among children with the disease, 72% are diagnosed with bone lesions by age 6, and 92% are diagnosed with
ages 12 to 18.
Since these signs and symptoms appear in many other diseases, it is difficult for them to immediately
identify Gaucher disease, which often results in a significant delay between the onset of symptoms and
diagnosis. To learn more, visit Diagnosing Gaucher Disease.

Below are some of the specific signs and symptoms of Gaucher disease:

Hepatosplenomegaly

Patients with Gaucher disease may have bloating due to an enlarged liver and / or spleen,
due to the accumulation of Gaucher cells.The spleen can enlarge up to 85 times its normal size, and
liver – up to 2.5 times. The defeat of these organs can affect other conditions of the body, including a decrease in
appetite (since enlarged organs press on the stomach, creating a feeling of fullness) and cytopenia,
associated with overactive spleen.

Thrombocytopenia

The accumulation of Gaucher cells in the bone marrow can cause a decrease in platelet count.Besides,
an enlarged, overactive spleen (due to accumulation of Gaucher cells) can destroy blood cells
faster than they are formed, thereby lowering the total platelet count. As a result, patients with
Gaucher disease may be prone to increased bruising and bleeding that may occur
even after the slightest injury due to disorders in the blood coagulation system and fibrinolytic
activity.

Anemia

When the spleen is enlarged from accumulated Gaucher cells, it becomes hyperactive (syndrome
hypersplenism), destroying red blood cells faster than the body produces them, which leads to anemia.
The resulting fatigue can be exacerbated by low endurance,
caused by the increased metabolism inherent in most patients with Gaucher disease.

Leukopenia

When the spleen is enlarged from accumulated Gaucher cells, it becomes overactive, destroying white blood cells
faster than usual. As a result, patients with Gaucher disease may develop increased
sensitivity to infections.

Bone crisis

Patients with Gaucher disease may experience severe bone pain or “bone crisis” as a result of a heart attack
bones (due to insufficient bone circulation) due to infiltration of Gaucher cells in the intramedullary
space and local release of chemical factors.Severe pain is often accompanied by fever and
can last from a few hours to a few days or even weeks, confining patients to bed for
this period.

Osteoporosis

In adults with Gaucher disease, bone mass may be less than it should be in people of their age
and sex, due to generalized demineralization, a decrease in the amount of cancellous bone and
thinning of the cortical layer.As a result of a decrease in bone density, it becomes weakened, which, in
in turn, makes it more prone to fractures.

Pathological fracture

Bones weakened by osteoporosis are susceptible to pathological fractures even from daily activity.

Bone deformation in the form of Erlenmeyer flasks

Manifestations of Gaucher disease include osteoclastic dysfunction and impaired bone remodeling.Most
Erlenmeyer flask-shaped bone deformity is a common manifestation in patients with Gaucher disease. V
in this case, the distal parts of the bone (usually the femur and tibia) acquire
an expanded and flattened shape instead of a normal round shape.

Literature

• 1.

  Charrow J, Andersson HC, Kaplan P, et al.The Gaucher registry: demographics and disease
  characteristics of 1698 patients with Gaucher disease. Arch Intern Med. 2000; 160: 2835-2843.

• 2.

  Brady RO, Barton NW, Grabowski GA. The role of neurogenetics in Gaucher disease. Arch Neurol.
  1993; 50: 1212-1224.

• 3.

  Taddei T, Kacena K, et al. The underrecognized progressive nature of N37OS Gaucher disease and
  assessment of cancer risk in 403 patients. Am J Hematol. 2009; 208-214.

• 4.

  Morales LE. Gaucher’s disease: a review. Ann Pharmacother. 1996; 30: 381-388.

• 5.

  Zimran A, Gelbart T, Westwood B, et al. High frequency of the Gaucher disease mutation at
  nucleotide 1226 among Ashkenazi Jews. Am J Hum Genet. 1991; 49: 855-859.

• 6.

  Beutler E, Grabowski G. Gaucher disease. In: Scriber CR, Beaudet AL, Sly WS, et al, eds. The
  Metabolic and Molecular Bases of Inherited Disease.7th ed. New York, NY: McGraw-Hill; 1995;
  2: 2641-2661.

• 7.

  Weinreb N, vom Dahl, S, A Report from the International Collaborative Gaucher Group (ICGG)
  Gaucher Registry ASH, 2008, 1, 2.

• 8.

  Kaplan, Paige, et al.The Clinical and Demographic Characteristics on Nonneuronopathic GD in
  887 Children at Diagnosis. Archives of Pediatrics and Adolescent Medicine.
  2006; 160: 603-608.

90,000 Does it hurt on the left, under the ribs? This could be the spleen

The spleen is an organ located behind the stomach, in the upper left of the abdominal cavity. Being just below the ribs, it cannot be palpated. Sometimes the spleen may be painful, causing a burning sensation just below the ribs on the left. The area may be painful and touching.

The spleen is a punch-sized body, part of the immune system, but you can live without it because the liver is capable of important functions.

The functions of the spleen include:

• Protect the body from germs by activating white cells
• Keep white and red cells under control
• Monitor blood and remove diseased cells.

When the spleen is not working properly, it can remove healthy cells, which means it can cause anemia, increase the risk of infection, and contribute to bruising and bleeding.

The spleen becomes painful either if it is damaged, or as a result of rupture of the spleen, or in case of an increase in its volume (enlargement of the spleen).

Pain due to ruptured spleen

Rarely, the spleen is injured or bumped during impact because it is protected from its location.However, there are situations in which the spleen can be affected – for example, after a traffic accident, during contact sports or because of a broken rib. In such situations, rupture of the spleen can occur, as well as a hematoma, which, in turn, can turn into a cyst. The spleen may rupture immediately after a stroke, but after a few weeks.

How does spleen rupture pain manifest?

Signs and symptoms of ruptured spleen are as follows:

• Pain in the left side of the abdomen, under the ribs and sensitivity to touch
• Cardiovascular instability manifested by tachycardia and dizziness
• Nausea, vomiting, pallor, fainting.

A ruptured spleen is a medical emergency because the bleeding can be severe and could endanger the patient’s life.

Pain caused by an enlarged spleen – splenomegaly

Splenomegaly is another cause of spleen pain. This condition can occur for several reasons, from bacterial infections such as malaria, tuberculosis and syphilis to cirrhosis of the liver, hemolytic anemia, or leukemia.Another cause of splenomegaly may be medication that has an adverse effect on the inflammation of the spleen.

How does it hurt if the spleen is enlarged?

In splenomegaly, spleen pain may be associated with symptoms such as:

• Setting satiety despite a small amount of food consumed
• Discomfort in the left abdomen, under the ribs
• Anemia, fatigue
• Frequent infections
• Rapid swelling of the skin.

An enlarged spleen can be treated with medications and can also be restful. This is because splenomegaly increases the risk of rupture of the spleen. Surgery is rarely required if the spleen is enlarged and complications arise.

How to treat spleen pain

If you have an enlarged spleen without accompanying symptoms, your doctor may consider this a good idea. Therefore, they will reevaluate you after 12 months or if you have other symptoms to decide what treatment is needed.

If spleen pain persists and your doctor confirms the diagnosis of a ruptured spleen, surgical removal of the spleen may be necessary. Sometimes only part of this organ is removed, sometimes complete removal is required.

Although the spleen is not a vital organ, doctors weigh the decision to remove the spleen very much, because without the spleen, the patient’s health could be at risk of infection. Because of this, doctors may sometimes require the spleen to shrink with radiation therapy to avoid surgery.

To reduce the risk after removing the spleen, doctors recommend immunizing the patient by vaccination (influenza vaccine, pneumonia vaccine, meningitis, or hepatitis B vaccine). In addition, antibiotic treatment is recommended to reduce the risk of infections.

Spleen enlargement in adults – symptoms and treatment | SpaceHealth

An ailment such as an enlarged spleen in adults, or as it is also called splenomegaly, provokes pain, as the organ begins to press and pinch the nerve tissue.The reasons for this can be different: from infectious infection to blood disease, liver cirrhosis, etc.

Diagnostics

Diagnosis of the disease is carried out using ultrasound. During the examination, the placement of the organ, its size, as well as the expansion of the ducts are taken into account. There are 4 degrees of development of splenomegaly:

1 degree – a slight increase in the lower edge of the spleen (by 1 cm).

2nd degree – the lower edge is located between the umbilical cavity and the last rib.

Grade 3 – the location reaches the level of the umbilical cavity.

Grade 4 – the spleen completely fills the left abdomen.

During the last degree, very strong painful sensations appear, radiating to the shoulder blades and upper limbs. Patients describe the pain as cutting, aching, and acute.

Symptoms of an enlarged spleen in adults

The following symptoms can determine the development of this disease and start treatment in time:

• Decreased appetite.
• Onset of heartburn.
• Temperature rise.
• Increased perspiration at night.

After a certain period of time and in the absence of proper treatment, the manifestation of more serious symptoms begins, due to which any activity becomes impossible:

• An icteric tint appears on the skin and sclera of the eyes.
• Constantly pursued by nausea and vomiting.
• Weight is dropping too quickly.

How to treat an enlarged spleen

If the diagnosis is confirmed, the first step is treatment to eliminate the cause of the enlargement of the spleen.After that, it is necessary to undergo supportive therapy for another 6 months. If the disease has developed to 3-4 degrees, then in most cases an operation is necessary to remove this organ. After removal of the organ, the liver takes over all its function, but the likelihood of inflammation of the gallbladder or digestive organs increases. Therefore, throughout life, you will have to follow a diet. It is highly discouraged to eat fatty, fried, spicy foods, as well as canned foods and alcoholic beverages.

If your spleen is enlarged, the sooner you start treatment, the better.

Treatment of celiac disease, gluten intolerance, appointment with a specialist – MEDSI

The main goal in the treatment of celiac disease is to restore normal bowel function and, as a result, normalize weight.

The most important point in the treatment of celiac disease is adherence to a gluten-free diet – the patient’s diet should be completely free of foods containing this peptide.As a rule, this measure allows you to restore bowel function within the first few months. It is important to understand that you will have to adhere to such a diet throughout your life.

In parallel with the appointment of a diet to replenish the deficiency of vitamins and microelements, multivitamin complexes and calcium and iron preparations can be prescribed.

In severe cases, when the inflammation cannot be corrected by diet, the gastroenterologist prescribes hormonal agents for 1.5-2 months.

Gluten-free diet

The Gluten Free Diet is a diet that is free of the protein gluten found in barley, wheat and rye. Gluten causes inflammation of the small intestine, which is accompanied by bloating and profuse diarrhea.

The basic principle of celiac disease is to avoid gluten-rich foods. These include wheat, oats, rye, barley and spelled wheat. However, the simple elimination of bread and oatmeal is unfortunately not enough for proper nutrition.The fact is that finished products may contain gluten or traces of it. Therefore, every celiac disease patient should have a list of foods that contain not only overt but also hidden gluten.

Permitted food:

• Buckwheat and corn grits and flour
• Gluten Free Flour (Rice & Bean)
• Polenta, tapioca and rice
• Legumes (beans, lentils, peas)
• Red meat, fish, poultry
• Fruits, berries, vegetables
• Fermented milk products

Products with explicit gluten

• Oat, wheat, oatmeal, pearl barley and semolina porridge
• Products prepared using wheat, rye, oatmeal or barley flour: bread, rolls, cakes, rusks, including for breading
• All types of pasta
• Ready cutlets, sausages, sausages – these products almost always contain gluten

Products with hidden gluten

Unfortunately, the presence of cereals is not indicated in the composition of some products, however, they may be present there in small quantities – this is enough to provoke unpleasant symptoms in the intestines.

The list of such products includes:

• Candy, chocolate, ice cream
• Canned meat and fish
• Mayonnaise and ketchup
• Industrial sauces and vinegar
• Soy products
• Malt extract
• Instant coffee and cocoa powder
• Stock cubes

It is also recommended to abstain from whole milk, however fermented milk products can be consumed without restriction.

Special gluten-free food products are currently being produced.

It is very important not only to choose the right food, but also to follow certain rules of cooking.

• Before cooking, the dishes, knife and cutting board must be thoroughly cleaned and washed so that there are no traces of gluten on them
• Fat that has been in use should not be used to cook food for celiac patients, even if it was supposedly gluten-free.The same applies to water – prohibited water used once for making pastries containing gluten
• Surfaces suspected of containing contaminated substances must be covered with foil or impermeable baking paper before use
• One of the most important rules is that you should not touch flour and food products with your hands, as well as dishes that have been in contact with gluten-containing products

90,087 90,000 cost of abdominal ultrasound in ORTHOLAND

An abdominal ultrasound can help assess the condition of the liver, gallbladder, pancreas, spleen, kidneys, and retroperitoneal space.

The smallest tumor formations at the initial stage, enlarged lymph nodes, the presence of free fluid, pathology of the abdominal aorta, cysts, stones, polyps are visible on the screen.

How to prepare for an ultrasound scan of the OBP?

An ultrasound examination of the abdominal cavity requires preparation and adherence to a diet:

1. 2-3 days before the procedure, you should not eat foods that contribute to gas formation: legumes, cabbage, whole grains, milk.
2. Dinner on the eve of the procedure should be early.
3. Ultrasound can be performed both in the morning (do not eat for at least 6 hours and do not drink for 2 hours), and after 15 hours, provided that the breakfast was light and small.
4. In case of digestive problems, it is recommended to take drugs that reduce gas production in 2-3 days.
5. Do not chew gum, suck lollipops, or smoke before testing.

Food in our stomach inhibits the propagation of waves, which negatively affects the accuracy of the result.

Indications for the study

We recommend doing ultrasound for everyone once a year as part of a prophylactic examination, as well as for the following symptoms:

• pains of varying intensity in the abdomen, discomfort;
• indigestion: constipation, stools, heartburn, bloating, flatulence, vomiting;
• violation of urination; feeling of heaviness in the abdomen after eating; lack of appetite;
• frequent belching, bitterness in the mouth, bad breath, nausea;
• palpable lesions;
• injuries.

Prices

• Ultrasound of the abdominal organs with the definition of function – 36 BYN.
• Without function definition – 30 BYN.
• With determination of function + kidneys, adrenal glands and bladder with determination of residual urine – 47 BYN.
• Without determination of function + kidneys, adrenal glands and bladder – 40 BYN.

We invite you to the medical center “Ortoland” in Minsk, where you can do an ultrasound scan for a fee for a child and an adult without queues and using modern equipment.We have highly qualified specialists and a modern center with all the necessary conditions for successful treatment.

Diseases We Treat | Center for Chinese Medicine TAO

Traditional Chinese Medicine (TCM) has been treating diabetes for over 2000 years. Chinese doctors have had a good understanding of diabetes since ancient times. One of the oldest books on Chinese medical theory, Huangdi Neijing, compiled around 100 BC.BC BC, the state known as Xiaoke is mentioned. This translates to “diabetes” or “diabetic wasting”. The literal translation of the term is “exhaustion-thirst”.

During the existence of TCM, its own, special point of view regarding the disease and its own approach to treatment have been developed. Chinese medicine has identified acupuncture techniques, herbal teas, exercise therapy techniques, and diet therapy to help control blood sugar levels.

Read completely

Diabetes mellitus

Causes of diabetes mellitus from the point of view of TCM

In Traditional Chinese Medicine, diabetes is viewed as organ damage in the upper, middle, and lower parts of the body.In the upper part, the lungs are affected, causing great thirst. In the middle, the stomach and spleen, causing excessive hunger. Finally, the kidneys are affected at the bottom, causing excessive urination.

Let’s say right away – in TCM there is no such thing as a genetic predisposition to diabetes. According to the Chinese, a person’s health depends primarily on the food he eats, on his physical activity, on the general standard of living and on the emotions that a person experiences.These factors are much more important than age and heredity. It is they who determine the correct functioning of the internal organs – which means that they are responsible for whether a person gets diabetes or not.

According to TCM, diabetes mellitus occurs due to several main factors:

• Improper nutrition. Consumption of large amounts of sweets, fatty and fried, heavy food, alcohol leads to acidification of the blood, which becomes aggressive towards other organs – kidneys, liver, bone marrow, spleen.Drinking excessively hot drinks is harmful, first of all – coffee and tea.

• Emotional disorders (stress, anxiety, depression). The emotional state of a person is associated with the work of internal organs, primarily the liver.

• Yin deficiency – fatigue of a certain organ. With Yin deficiency, the organ cannot function normally. Diabetes is a Yin deficiency in the liver and spleen.

• Passive lifestyle.It affects the health of the spleen and causes lymph stagnation, which negatively affects all organs of the human body, primarily the intestines.

For Chinese doctors, a diabetic condition is not just a matter of one or two problems in the body. This is a complex of disorders throughout the body. And the root of all these disorders is a certain syndrome or a combination of 2-3 syndromes, which will be discussed below. Therefore, even if two patients are diagnosed with the same type of diabetes, these people may have different types of TCM disorders and will be treated differently.

Seven diabetes mellitus syndromes according to TCM

Qi stagnation due to liver depression

TCM explains this syndrome as follows – negative emotions can lead to diseases. Depression in the liver can lead to stagnation of Qi (life energy) and cause emotional imbalances, so calming the liver and regulating Qi are the main principles of treatment.

Symptoms: depressed mood, frequent sighing, nervousness, bloating, and a bursting feeling of fullness in the chest and sides, pale tongue with a thin white coating, sinewy pulse.

Stagnant heat in the liver and stomach

This is the next stage when the Qi stagnation turns into fever.

Symptoms: irritability, chest fullness and fullness, excessive thirst and increased urination, eating large amounts of food, excessive appetite, bitter taste, dry and bad breath, constipation, red tongue, fast and sinewy pulse.The elimination of heat in the liver and stomach is an important therapeutic principle for this type.

Stagnant heat and mucus

This syndrome is common in the early and middle stages of diabetes mellitus, especially in patients who smoke and drink alcohol. It is common in relatively obese people, as in TCM theory “obese people tend to accumulate a lot of mucus.”

Symptoms: fullness in the abdomen, feeling of pressure in the chest, bloating, dry and bitter taste in the mouth, preference for cold drinks, constipation, red tongue with a yellowish greasy coating, yellow urine, sinewy and smooth pulse.

Excessive heat in the stomach and intestines

This is one of the main syndromes that occurs in the middle stage of type 2 diabetes.

Symptoms: Consuming large amounts of food that stagnates and creates warmth in the stomach and intestines, bloating, constipation, bitter taste, dry mouth with an unpleasant odor, thirst with desire for cool water, constant hunger, red tongue with yellow coating, fast strong pulse …

Dampness and heat in the intestines

This syndrome always appears in the middle stage of type 2 diabetes.

Symptoms: thirst without the desire to drink, hunger without the desire to eat, a bitter taste and a sticky sensation in the mouth, bloating, foul-smelling sticky stools, red tongue with a yellow and greasy coating, slippery pulse.

Deficiency of body fluids due to excessive heat

When exposed to the pathogens of fire and heat during the progression of type 2 diabetes, Chi energy is depleted and fluids gradually evaporate from the body.

Symptoms: dry throat and mouth, thirst with desire for cold water, overeating with a lingering feeling of hunger, frequent urination, irritability, bitter taste in the mouth, red urine, constipation, red tongue with a yellow coating, rapid pulse.

Simultaneous deficiency of Qi and Yin

The syndrome occurs in the late stage of diabetes or the deficiency stage. The pathogens of fire and heat continue to destroy the Qi energy of the Zang-Fu organs (small / large intestine, lungs, spleen, kidneys), and then complete destruction of Qi occurs.In addition, fire and heat dry out liquids and damage yin.

Symptoms: dry mouth and throat, thirst with large amounts of fluids, loss of spirit and lack of energy, shortness of breath and unwillingness to talk, exhaustion of the body, pain in the lower back and knees, spontaneous night sweats, fever in the palms and feet, belching, tachycardia, insomnia , red tongue with a thin dry coating, thin rapid pulse.

Why is it important to know this?

Why should a modern person know the classification of diabetes according to BMT?

Each of these syndromes has its own special treatment.It largely depends on the characteristics of the patient and is selected strictly individually. There are no standard treatment algorithms in TCM. From the point of view of TCM, different syndromes cannot be treated with the same herbal preparations and techniques. What works for one patient may not work for another. The main methods of working with diabetics are a combination of acupuncture practices, diet, exercise and herbal medicine. Also, the patient may be assigned additional procedures.

How Diabetes Mellitus Cures Chinese Medicine

Modern Western medicine treats diabetes with insulin injections and oral medications, diet.Patients are prescribed strict control over sugar levels. In many ways, treatment focuses on treating the symptoms of diabetes rather than targeting the source of those symptoms.

Unlike Western medicine, TCM does not strictly control blood sugar levels in people with diabetes.

A Chinese medical practitioner performs a detailed diagnosis, even if the diagnosis is already known. The doctor observes the shape, color and coating of the tongue; he evaluates the color and expression of the face; breath and body odor; strength, rhythm and quality of the pulse.

The task of TCM is, first of all, to cleanse the human body. It is for this purpose that medicinal herbs are used. The TCM practitioner uses it to cleanse and cleanse the patient’s intestines, lymph and blood. Through this, a general cleansing of the body and the normalization of its work begins.

Through acupuncture, moxa heating, massage, herbal medicine, diet and exercise, BMT doctors improve the functioning of the pancreas, which is responsible for the production of insulin.They act on the endocrine system, triggering regeneration processes in it.

It must be said that TCM techniques will not be able to completely free an insulin-dependent person from injections.

However, BMT techniques can prevent long-term complications and improve the quality of life. Acupuncture course allows you to reduce the level of your daily dose of insulin. In addition, you can forget about the frequent urge to urinate, the false feeling of hunger, constant thirst, increase concentration, and improve sleep.And most importantly, BMT allows you to increase life expectancy, to maintain the kidneys, spleen, gastrointestinal tract and other internal organs in order.

In patients who are not dependent on insulin who are treated with Chinese medicine, blood sugar levels decrease, and in the early stages of diabetes, sugar levels return to normal.

Also, regular acupuncture treatments are beneficial in reducing stress levels. This is very important because stress can trigger a burst of hormones that signal the liver to release more sugar into the bloodstream.This can be fatal for a diabetic. Acupuncture reduces stress levels, and for a diabetic, keeping stress levels to a minimum is critical.

If the patient during the treatment keeps his body in good shape, monitors the diet, the positive effect of the complex treatment can come much faster.

Are you worried about diabetes or its consequences? Sign up for a diagnosis at the TAO Clinic of Traditional Chinese Medicine.