Splenic Conditions

 

What is the Spleen?

The spleen is an organ in the upper left part of the abdomen that is about 4 inches long. It’s protected by the rib cage so you can’t usually feel the spleen unless it is unusually enlarged. The spleen has multiple functions in the body - it acts as a filter for blood as part of the immune system and also helps to fight certain kinds of bacteria.

 

It is not uncommon for people to experience various conditions of the spleen including an enlarged spleen or an infection.The spleen is a small organ in the upper left hand side of your system and is protected by your ribs.

 

Enlarged Spleen and Spleen Infections



Many conditions, including infections, liver disease and some cancers, can cause an enlarged spleen. At the Boston Liver, Pancreas and Biliary Center at St. Elizabeth’s our multidisciplinary team of hematologists, gastroenterologists and oncologists are highly skilled in caring for the various conditions that can affect the spleen. Our team will work together with you to explain your condition and all treatment options so that you can be sure you’re getting the care that’s right for you.

 

 

Symptoms of an Enlarged Spleen



An enlarged spleen usually doesn’t cause symptoms and is often found during a routine medical exam. Your doctor typically can’t feel a regular-sized spleen, but will be able to feel an enlarged spleen. Imaging and blood tests can help determine the cause of an enlarged spleen. 

 

An enlarged spleen often doesn’t cause symptoms but when it does, they can include:

-    Pain or fullness in the upper left part of the abdomen that could spread to the left shoulder

-    Feeling full without eating or after eating small amounts of food

-    Anemia

-    Fatigue

-    Infections

-    Bleeding

 

What Causes an Enlarged Spleen

A variety of infections or conditions can cause an enlarged spleen, which may be temporary. Some of these causes include:



-    Viral infections like mononucleosis

-    Bacterial infections like syphilis (a type of sexually transmitted disease) or endocarditis (infection of the heart’s inner lining)

-    Parasitic infections like malaria

-    Cirrhosis and other liver diseases

-    Blood cancers, such as leukemia and lymphomas, such as Hodgkin’s disease

 

 

 

Treatment for an Enlarged Spleen



Treatment depends on the type of medical condition that is causing the spleen to become enlarged. For example, if your spleen is enlarged from viruses like mononucleosis, typically treatment is not necessary, but your doctor will likely recommend you stay away from any physical activity that could cause the spleen to rupture.

If other conditions cause serious complications, spleen removal may be necessary. Many symptoms cause an enlarged spleen and it may need to be removed surgically.

 

Ruptured Spleen



The spleen is a very sensitive organ and can rupture or get damaged, even when healthy. The possibility of a ruptured spleen is greater when the spleen is enlarged. A ruptured spleen can occur immediately after an injury; for example, it’s common in car accidents. Or in some cases, it can happen days or weeks after an injury. Symptoms of a ruptured spleen can include left-side abdominal pain, left shoulder pain, lightheadedness, confusion, dizziness and blurred vision. Some people may also experience shock as a result of massive blood loss. A ruptured spleen can cause life-threatening bleeding and needs immediate treatment.

 

 

Sickle Cell Disease – How it Affects the Spleen



With this inherited condition, blood cells become misshapen and break down into a sickle shape, similar to a crescent moon. The cells die early, leaving a shortage of healthy red blood cells and can block blood flow, which can lead to organ damage, including damage to the spleen. Sickle cell disease is considered a rare condition, in that fewer than 200,000 cases are diagnosed each year in the U.S.

 

Infections, pain and fatigue are common symptoms of sickle cell disease. Periodic episodes of pain, called pain crises, are a major symptom of sickle cell anemia. Pain develops when the sickle-shaped red blood cells block blood flow to your chest, abdomen and joints. 

The pain varies in intensity and can last for a few hours to a few weeks. Some people have only a few pain crises a year. Others have a dozen or more pain crises a year. A severe pain crisis requires a hospital stay.

Some adolescents and adults with sickle cell anemia also have chronic pain, which can result from bone and joint damage, ulcers, and other causes.

Other symptoms of sickle cell anemia include:

- swelling of the hands and feet

- frequent infections

- delayed growth or puberty in children and adolescents

- vision problems

Sickle cell disease is usually diagnosed in infancy through newborn screening programs. For a baby to be born with sickle cell disease, both parents must carry a sickle cell gene. Otherwise, there is no risk of developing the condition.

 

Treatment for Spleen Conditions 



Although the treatment varies depending on the condition, some spleen conditions require a splenectomy or spleen removal. Your spleen may be removed for a number of reasons including:

 

  • Cancers - Hodgkin’s lymphoma and non-Hodgkin’s lymphoma are the main reasons for a spleen removal. Certain types of leukemia may also spread to the spleen and be a reason to have your spleen removed.
  • Blood disorders
  • Enlarged spleen
  • Infection
  • Trauma

Spleen removal surgery can be done laparoscopically with small incisions if the spleen is not massively enlarged. If the spleen cannot be removed through this technique, surgeons will use a large, “open” incision.

People can live a healthy life without their spleen. The liver will take over a lot of the functions that the spleen was previously responsible for.

 

Recent Medical Research

Vega EA, Yamashita S, Shin CY, Kim M, Fleming JB, Katz MH, Raghav KP, Vauthey JN, Lee JE, Conrad C. Laparoscopic Partial Splenectomy for Unknown Primary Cancer: A Stepwise Approach. Ann Surg Oncol. 2017 Apr;24(4):1134. doi: 10.1245/s10434-016-5664-7. Epub 2016 Dec 9. PMID: 27942901.

Nakata K, Shikata S, Ohtsuka T, Ukai T, Miyasaka Y, Mori Y, Velasquez VVDM, Gotoh Y, Ban D, Nakamura Y, Nagakawa Y, Tanabe M, Sahara Y, Takaori K, Honda G, Misawa T, Kawai M, Yamaue H, Morikawa T, Kuroki T, Mou Y, Lee WJ, Shrikhande SV, Tang CN, Conrad C, Han HS, Chinnusamy P, Asbun HJ, Kooby DA, Wakabayashi G, Takada T, Yamamoto M, Nakamura M. Minimally invasive preservation versus splenectomy during distal pancreatectomy: a systematic review and meta-analysis. J Hepatobiliary Pancreat Sci. 2018 Nov;25(11):476-488. doi: 10.1002/jhbp.569. Epub 2018 Aug 16. PMID: 29943909.

Goumard C, Ogiso S, Okuno M, Fleming JB, Kim M, Tzeng CD, Vauthey JN, Lee JE, Conrad C. Tips and tricks of splenic vessel preservation during laparoscopic distal pancreatectomy. Surg Endosc. 2018 Apr;32(4):2149-2150. doi: 10.1007/s00464-017-5744-1. Epub 2017 Jul 21. PMID: 28733741.

 

 

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