Internal Medicine

Swollen spleen

introduction

A swelling of the spleen, i.e. its increase in size, is referred to in medical jargon as splenomegaly.

In the majority of cases it does not cause any symptoms and is often a chance diagnosis. It can occur in the context of infectious diseases as well as malignant diseases. Whether and to what extent therapy is necessary depends on the underlying disease.

causes

Can be a cause of enlargement of the spleen Infections with bacteria or viruses be. A typical example of this is that Pfeiffer's glandular fever. It develops after being infected with the Epstein Barr Virus (EBV). Young people are very often affected by the disease. It is often associated with swelling of numerous lymph nodes, and it is not uncommon for the liver and spleen to enlarge (see also: swollen liver).

Even with one malaria the spleen may swell. Another possible cause of a spleen enlargement are so-called Storage disorders. This leads to deposits of insufficiently degraded metabolic products. The deposits can take place in the spleen, which then leads to an increase in size. An example of such a storage disease is the Gaucher's disease. Also the Amyloidosis is one of the storage diseases that can be associated with an enlarged spleen.

Furthermore, a High pressure in the portal vein system (Liver vessels) cause the spleen to swell. Such a high pressure can occur, for example, in a Right heart weakness or at one Cirrhosis of the liver come.

Glandular Pfeiffer fever

Pfeiffer's glandular fever, also known as mononucleosis, is a viral disease caused by the Epstein-Barr virus.

Young people are often affected. Flu-like symptoms and fever develop, and the lymph nodes swell significantly. Swollen tonsils and a sore throat are also common. The disease can sometimes drag on for months and in later stages mainly manifest as tiredness, exhaustion and reduced performance. It is not uncommon for the spleen and / or liver to become significantly enlarged.

There is no causal therapy because antibiotics do not help with viral diseases. The symptoms can be treated, for example with antipyretic and anti-inflammatory drugs.

leukemia

Last but not least, malignant diseases are the cause of an increase in the size of the spleen. Particularly in certain types of leukemia (blood cancer), pronounced splenomegaly can develop.

This occurs through the following mechanism: The human blood components (red blood cells, platelets, white blood cells) are normally produced in their bone marrow. In leukemia, many cancer cells multiply in the bone marrow. These produce a kind of cell clone, so the cancer cells only produce white blood cells. Because the cancer cells keep multiplying, they eventually flood the bone marrow and the normal cells that were supposed to produce the other blood components no longer have any space. So you have to move elsewhere. In patients with leukemia, it can happen that blood formation is shifted from the bone marrow to the spleen and liver, which is referred to as extramedullary blood formation. This leads to a significant swelling of the liver and / or spleen.

Spleen swelling after a cold

A swelling of the spleen after a simple cold is rather uncommon. Such swelling is more likely to occur during certain infectious diseases such as Pfeiffer's glandular fever.

Spleen swelling from alcohol

Alcohol has little effect on the spleen. Therefore, alcohol consumption usually does not lead to an enlargement of the spleen. Chronic alcohol consumption, however, leads to cirrhosis of the liver in some patients, which in turn can occasionally cause spleen swelling.

diagnosis

An enlarged spleen often causes no symptoms and can therefore be an incidental finding. A healthy spleen cannot be felt. If the spleen swells significantly, it can be felt under the left costal arch. In some diseases, the spleen is so enlarged that it extends down into the pelvis.

In addition to the physical examination, the ultrasound examination of the abdomen is primarily used. Here an enlarged spleen can be easily recognized and precisely measured. With regard to the triggering cause, the anamnesis is decisive. The doctor may ask questions about stays abroad, contact with sick acquaintances, other complaints and previous illnesses. A blood test can also be done. Here, for example, increased inflammation values can be noticed as part of an infection. There are also markers that indicate heart failure, which can sometimes lead to a swelling of the spleen. Cancer diseases such as leukemia can also be seen in the blood.

How do I know if I have a swollen spleen in myself?

An enlarged spleen alone often does not cause any symptoms and is not an independent disease but a symptom of various diseases.

If you have flu-like symptoms, fever or fatigue, these can in some cases be accompanied by an enlarged spleen. However, common colds or the flu are usually not associated with an enlarged spleen. The enlargement of the spleen is only of moderate importance for the time being, since it does not result in any significant new facts. A spleen swelling can be recognized without medical aids just by feeling it. The swelling of the spleen can already be felt in a physical examination in the abdomen under the left costal arch. Among other things, it can be determined whether the spleen capsule is stretched and whether the surface of the spleen appears smooth or nodular.

Usually the swelling of the spleen does not cause any symptoms at first, only later it can lead to unpleasant pulling pains under the left costal arch. The swelling can also affect other abdominal organs and pain. This can lead to liver pain or stomach pain. In addition, a displacingly growing spleen can obstruct the diaphragm and lead to shortness of breath and breathing disorders. Further symptoms often only arise in the long term as a result of the functional impairment of the spleen and the progression of the underlying disease.

How do I feel a swollen spleen?

In healthy people, the spleen is generally not palpable.

It is hidden above the left kidney under the left costal arch. If the organ swells, it can protrude under the left costal arch and then be palpable. With a strong enlargement, the spleen can reach very far down into the abdomen. To feel the spleen, you can breathe in deeply and feel deeply with a few fingers just below the costal arch. At the end of the inhalation or at the beginning of the exhalation, you can possibly feel how the edge of the spleen pushes out from under the costal arch or how it disappears again under the costal arch. When inhaling deeply, the spleen is shifted downwards, when exhaling again upwards.

Concomitant symptoms

The symptoms that accompany an enlarged spleen depend very much on the underlying disease.

Initially, the swelling of the spleen can be noticed as pulling and pressing pain in the left upper abdomen, which can be accompanied by stomach discomfort and breathing restrictions. A functional impairment of the spleen can lead to an increased susceptibility to infection, thrombosis and changes in the blood count. In the course of the spleen swelling can progress, leading to a threatening rupture of the spleen. In addition to pain, this can lead to slow bleeding symptoms with weakness, fainting and reduced performance, which can be a life-threatening clinical picture.The many causes of spleen swelling can cause other symptoms. Important accompanying symptoms that require further clarification are fever, cough, swollen lymph nodes, fatigue, weight loss or night sweats.

The presence of glandular fever can lead to fever, flu-like symptoms, lymph node swelling, swelling of the tonsils with a sore throat as well as noticeable fatigue and exhaustion.

In malaria, cyclical attacks of fever lasting a few days are a relatively typical symptom.

If a weak heart is responsible for the swelling of the spleen, there may be shortness of breath with low stress.

If leukemia is the cause of an enlarged spleen, symptoms such as increased susceptibility to infections, fatigue and reduced performance, increased bruising and night sweats can occur. Often there is also swelling of the lymph nodes in different regions.

Swollen spleen and lymph nodes

A swelling of the spleen and lymph nodes can be triggered by an infection or by cancer. In Pfeiffer's glandular fever, for example, there is regularly a significant swelling of various lymph nodes, often accompanied by fever, body aches and fatigue. But even with blood cancer or lymphoma, i.e. malignant cancers, the spleen and lymph nodes can swell. For lymph node swelling that does not go away after a few days, enlarged lymph nodes that are not tender to pressure or strongly bonded to the surrounding tissue, should therefore be presented to the attending physician as soon as possible.

Swollen spleen and liver

A swelling of the liver and spleen is referred to in medical jargon as hepatosplenomegaly. The causes of this are often similar to those of an isolated swelling of the spleen.

In leukemia, hepatosplenomegaly can occur due to the necessary blood formation outside the bone marrow.

Virus infections such as Pfeiffer's glandular fever or tropical diseases such as malaria can also cause both organs to swell. The liver and spleen can then be palpated under the right (liver) or left (spleen) costal arch. The enlargement often only disappears completely after months, namely when the disease has been cured or treated.

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What to do if you have a swollen spleen

Since a swelling of the spleen is usually not noticed, the question of what to do often does not arise. If it is felt by accident, the attending physician should be consulted. He can then decide whether further diagnostics are necessary. The path to a diagnosis can then be paved with the help of anamnesis, physical examination and blood tests.

Can that be an indication of cancer?

A rare cause of spleen swelling is cancer.

Numerous cancers of the blood or lymphatic system can cause spleen to swell. These diseases differ greatly in their severity, symptoms, therapy and prognosis. Usually, a spleen removal is not necessary in the course of this. Many of these illnesses can initially make themselves felt as fever, night sweats, fatigue, weight loss and a poor general condition. Today, most of these conditions can be treated well and successfully, so the overall prognosis is better.

Duration

The duration of a spleen swelling depends very much on the triggering cause. In the case of infectious diseases, the swelling can persist for weeks to months until the infection has completely subsided. If the spleen is swollen as part of leukemia, it can also last for a longer period of time, namely until the therapy initiated has shown an effect.

forecast

The prognosis for spleen swelling is very variable and depends on the underlying cause.

Most spleen swellings can be traced back to infections caused by pathogens. In these cases, depending on the course of the disease, healing and elimination of the pathogens can be expected, which also reduces the swelling of the spleen. On the other hand, spleen swellings are less common and do not resolve on their own, as is the case with severe spleen bleeding after an accident.

Even if the spleen is removed, the life expectancy of the person affected is usually not restricted. Only various precautionary measures have to be observed in a condition after the spleen has been removed. Life-threatening cancers are rarely behind the swollen spleen. Overall, their prognoses are very different, with some having a good chance of recovery, but others having poor prognoses.