Internal organs

Enlarged spleen

Enlarged spleen


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Splenomegaly

An enlarged or splenic swelling (medical splenomegaly) is an acute or chronic enlargement of the spleen, which can lead to abdominal pain, nausea and vomiting and a feeling of fullness. Splenomegaly is not an independent disease, but a finding that can have very different causes, analogous to the different functions of the spleen - in most cases, however, there are infectious diseases (e.g. Pfeiffer glandular fever) or blood disorders (e.g. leukemia or Hodgkin's disease) Before, splenomegaly can also arise, for example, from rheumatic diseases or blood poisoning (sepsis).

Synonyms

Enlargement of the spleen, enlargement of the spleen, splenomegaly, spleen pain, enlarged spleen.

The spleen

The spleen (Latin: Lien, Greek: Splen) is an approximately 11 × 7 × 4 centimeters large and 150 to 200 grams heavy organ, which belongs to the so-called "lymphatic system" and is located in the left upper abdomen, more precisely below the diaphragm and above the left kidney, located. The bean-shaped organ is surrounded by a tight connective tissue capsule, which protects the actual spleen tissue - the splenic pulp - and has three essential functions: On the one hand, certain white blood cells (the so-called B and T lymphocytes) mature in it to ward off foreign substances. On the other hand, it is used for the filtration and breakdown of aged red blood cells and as a storage location for white blood cells and platelets (monocytes). The different functions of the spleen also become clear in terms of color: the area responsible for immune defense appears white (white pulp), while the blood filter of the spleen is deep red (red pulp).

In addition to the actual spleen, around 10 percent of people also have one or more so-called "secondary spleens" (splen accessorius), i.e. small nodular organs made of spleen tissue, which are identical in structure and function to the "main spleen" and are usually located near the spleen portal. If a spleen has to be removed surgically due to a disease, these secondary spleens also become relevant - because without a complete removal of all spleens, the disease cannot heal completely.

Before birth and in toddlers, the spleen is a vital organ, since it is significantly involved in the formation of white blood cells and (somewhat less) red blood cells. For adults, on the other hand, it is not vital because its functions can be carried out by the liver, bone marrow and other lymphatic organs. Accordingly, removal of the spleen (e.g. as a result of heavy bleeding) usually does not result in any serious complications, but it is often the case that those with an inoperable or missing spleen are more susceptible to infections.

Definition enlarged spleen

An enlarged spleen (splenomegaly) denotes an acute or chronic enlargement of the spleen, i.e. in the normal case an increase in organ weight by 350g or exceeding the normal values ​​(length 11cm, width 7cm, thickness 4cm). A distinction is made in three stages for more precise determination of the extent of splenomegaly: for example, in the case of mild splenomegaly, the organ weight is less than 500 g, in the case of moderate splenomegaly it is between 500 and 800 g and in the case of a massively enlarged spleen it is over 1,000 g.

Symptoms

In many cases, a swollen or enlarged spleen hardly causes any symptoms. However, if the spleen becomes so large that it presses on the stomach or other organs in the abdominal cavity, there is often a feeling of fullness, general malaise or nausea and vomiting. In some cases, pressure symptoms occur while eating, in other cases, however, without eating. In addition, spleen pain as a result of an enlarged organ sometimes occurs in the form of abdominal pain and / or back pain in the spleen region, in some people the pain also extends to the left shoulder, chest or back.

In most cases, however, symptoms of the disease that are the basis of the enlargement of the spleen are primarily evident: fever (e.g. with infections), painful swollen lymph nodes on the neck (with Pfeiffer glandular fever) or joint problems (with rheumatic diseases) often occur here.

In addition, an enlarged spleen can lead to hyperfunction (hypersplenia syndrome), i.e. H. lead to an excessive breakdown of blood cells, which is often accompanied by typical symptoms of anemia such as pallor, tiredness, weakness or rapid heartbeat. If there is a deficiency of white blood cells in this context, this often means a higher susceptibility to infectious diseases, in the case of low platelets it can also affect e.g. nosebleeds occur more quickly.

Causes of enlarged spleen

In most cases, splenomegaly is a result of other diseases or infections, and only rarely is there a disease that only affects the spleen itself. Often there are diseases of the blood or the lymphatic system, such as. B. leukemia or Hodgkin's disease, a malignant tumor of the lymphatic system.

In addition to this, an enlarged spleen is also often caused by infectious diseases such as Tuberculosis, malaria or Pfeiffer's glandular fever, a common and usually harmless disease caused by the Epstein-Barr virus. Blood poisoning (sepsis) can also be considered as a cause, in which an infection spreads in an uncontrolled manner in the body, which can quickly become life-threatening and must therefore be treated quickly.

Rheumatic diseases such as systemic lupus erythematosus or so-called "storage diseases" can also cause splenomegaly, i.e. Metabolic disorders, in which there is an accumulation of metabolic products in tissues and organs, which are subsequently changed pathologically (such as Gaucher's disease).

In addition, a blood congestion in front of the liver can be the trigger if the blood backs up from the gastrointestinal tract to the spleen instead of flowing through the portal vein through the liver. Such blood congestion can be caused by a number of diseases, e.g. liver cirrhosis, inflammation of the pancreas (pancreatitis) or inflammation of the liver (hepatitis). Also tumors or cysts, i.e. Splenic tissue cavities filled with fluid can cause splenomegaly.

Anemia in the form of spherical cell anemia can also be associated with an enlarged spleen. This most common haemolytic anemia in Central Europe is characterized by an abnormally high breakdown of red blood cells by the spleen. Finally, bruises (hematomas) or blood sponges (hemangiomas) of the organ can be considered as triggers of splenomegaly, which affect the spleen as such.

Diagnosis

In a first step, the doctor usually uses a physical examination to determine splenomegaly, because in contrast to healthy spleens, an enlarged spleen can be palpated to the left under the costal arch if the patient inhales deeply.

An ultrasound examination (sonography) and other imaging methods such as computer tomography can then provide information about the size of the spleen and the cause of the enlargement. In most cases, blood tests are also carried out - the size and shape of the blood cells provide information about the cause of splenomegaly, a bone marrow examination can also reveal blood cancer such as leukemia or lymphoma or an accumulation of undesirable substances (storage disease). With the help of a measurement of the protein content in the blood, diseases such as malaria and tuberculosis can also be excluded.

Another way to reliably identify splenomegaly or hyperfunction of the spleen (hypersplenia syndrome) is provided by so-called "scintigraphy" - an imaging procedure in nuclear medicine diagnostics in which the blood cells are stained with a special substance and can thus be made visible .

Therapies and treatment options

Treatment for splenomegaly is usually based on the underlying disease. If this can be cured successfully or brought under control, this usually has a positive effect on the enlarged spleen. However, if there is no success here or if there are further complications (e.g. anemia or a platelet deficiency), surgical splenic removal (splenectomy) is carried out in rare cases. Such an intervention can e.g. also necessary in the event of a splenic tear as a result of a serious accident The surgical procedure is very diverse - there is basically the possibility of removing the spleen completely (total splenectomy) or only partially (subtotal splenectomy). These procedures can be minimally invasive today, but depending on the underlying disease or the size of the spleen, open surgery may be appropriate.

Since the spleen plays an important role in the immune system in the human body, there is usually an increased risk of infection after infection with encapsulated bacteria (e.g. pneumococci, meningococci and Haemophilus influenzae) after surgical removal of the organ, in particular here forms of pneumonia, meningitis and Ear or sinus infections play a central role. Vaccination against the most common encapsulated bacteria has proven to be an important, very effective precautionary measure in patients after taking a spleen. With planned interventions, the patient is vaccinated if possible 2-3 weeks before the operation, whereby the vaccination must be repeated every 5-10 years, because infections with the bacteria mentioned can take a severe course after a splenectomy. Especially in children and adolescents, whose immune system is significantly weaker than in adults, there is often a particularly high susceptibility to the infections mentioned and mostly more serious illnesses - therefore, if possible, the spleen is only removed after the age of 6.

In some cases, radiation therapy of the entire organ with extremely low radiation doses (0.2 Gy) offers an alternative method to relieve symptoms caused by a swollen spleen.

Applications in naturopathy

Naturopathy often shows itself in terms of the diverse functions of the spleen as a useful and effective addition or alternative to conventional therapy. In general, in connection with spleen complaints, it is often recommended from a naturopathic point of view, in addition to the direct treatment of the spleen, to pay particular attention to a regulated acid-base balance and an appropriate diet, i.e. a balanced and natural food with many vital and mineral substances and vitamins.

While a special spleen diet hardly plays a role in local medicine, it is firmly anchored in traditional Chinese medicine (TCM) and is aimed at strengthening the spleen qi, which has the task of extracting the energy from the diet and it to make it completely available to the body. In this context, a slightly sweet and bitter diet is advised in the TCM, whereby the bitter substances should come from vegetables (e.g. fennel), fruits and herbs (e.g. coriander, cloves) and the sweetness is achieved by chewing extensively, because in this way the Carbohydrates are already being converted into sugar. Warm foods are also considered beneficial for the spleen, so the Chinese recommend a cooked meal with whole grain porridges
Wheat, oats, barley, rice, millet, corn and chestnuts. In addition, in many cases Legumes and nuts, lean meat from chicken, pheasant or sheep, some types of fish and various spices (e.g. cloves, star anise, nutmeg and cinnamon) are considered suitable.

In Western herbal and herbal medicine (phytotherapy) there are generally only a few medicinal plants that are believed to have a strong connection to the spleen - in the event of a swelling of the spleen, grindelia and scolopendrium (stag tongue fern) are possible, and bitter plants are also suitable, such as e.g. Calamus, gentian, ginger, dandelion or wormwood. The medicinal plants can generally be taken either as tea drugs or in the form of medicinal preparations as well as homeopathics. In the field of homeopathy, Ceanothus americanus is often used to enlarge the spleen.

Regardless of the specific naturopathic treatment option in question, a specialist should always be consulted first in order to rule out serious illnesses or injuries that may make surgical intervention necessary. In addition, each form of alternative medicine should be advised and coordinated with an appropriate expert so that the best possible therapy can be developed and risks can be excluded. (No)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Social Science Nina Reese, Barbara Schindewolf-Lensch

Swell:

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Video: Could Any of My Symptoms Be Spleen Related? (December 2022).