Overview

The spleen is a soft, spongy organ located in the upper left side of the abdomen, just beneath the rib cage and next to the stomach. It plays a crucial role in the body’s immune system and blood filtration processes. The spleen filters and removes old or damaged red blood cells, stores white blood cells and platelets, and helps fight infection by producing lymphocytes and antibodies. While not essential for survival, the spleen contributes significantly to maintaining a healthy immune response and proper blood composition. Diseases of the spleen can lead to enlargement (splenomegaly), overactivity (hypersplenism), or in rare cases, rupture, each of which requires medical attention.

Causes

Several conditions and diseases can affect the spleen, leading to its enlargement, dysfunction, or damage. Common causes include:

• Infections: Viral infections like mononucleosis, bacterial infections like syphilis, and parasitic infections like malaria can cause spleen enlargement.
• Liver Diseases: Conditions such as cirrhosis lead to portal hypertension, resulting in splenomegaly.
• Blood Disorders: Hemolytic anemia, thalassemia, and sickle cell disease cause excessive breakdown of red blood cells, increasing spleen workload.
• Cancers: Leukemia and lymphoma frequently involve the spleen, causing enlargement and functional impairment.
• Autoimmune Diseases: Conditions like systemic lupus erythematosus (SLE) or rheumatoid arthritis can inflame and enlarge the spleen.
• Trauma: Physical injury, such as a blow to the abdomen, can cause spleen rupture, leading to internal bleeding.
• Congestive Conditions: Congestion from blood clots in the splenic or portal veins can cause splenic enlargement.

Symptoms

Symptoms related to spleen problems can vary based on the underlying cause but commonly include:

• Upper Left Abdominal Pain: A dull ache or fullness in the upper left abdomen, which may radiate to the left shoulder.
• Feeling Full Quickly: Enlarged spleen can press on the stomach, leading to early satiety after small meals.
• Fatigue and Weakness: Often associated with anemia or low blood cell counts due to spleen overactivity.
• Frequent Infections: Dysfunction of the spleen can weaken immune defenses, making infections more common.
• Easy Bruising or Bleeding: Reduced platelet count (thrombocytopenia) from hypersplenism can cause these symptoms.
• Weight Loss: Unintended weight loss may occur in chronic conditions involving the spleen.
• Symptoms of Shock: In cases of spleen rupture, severe pain, rapid heart rate, low blood pressure, and fainting may occur due to internal bleeding, which is a medical emergency.

Diagnosis

Diagnosing spleen-related conditions involves a combination of medical history, physical examination, and diagnostic tests. Common diagnostic methods include:

• Physical Examination: A doctor may feel for spleen enlargement by palpating the upper left abdomen during a physical exam.
• Blood Tests: Complete blood count (CBC) to assess red cells, white cells, and platelets. Abnormal levels may indicate spleen dysfunction.
• Ultrasound: A non-invasive imaging method to determine spleen size and detect abnormalities.
• CT Scan (Computed Tomography): Provides detailed imaging of the spleen and surrounding organs, useful for trauma cases or suspected tumors.
• MRI (Magnetic Resonance Imaging): Occasionally used for further imaging detail, particularly for soft tissue evaluation.
• Bone Marrow Tests: May be recommended if blood cancers or marrow disorders are suspected as a cause of splenic problems.

Treatment

Treatment for spleen conditions depends on the underlying cause, severity of symptoms, and overall health status of the patient. Management options include:

Medical Management

• Treatment of Infections: Appropriate antibiotics, antivirals, or antiparasitic medications depending on the causative organism.
• Management of Underlying Diseases: Control of liver disease, autoimmune conditions, or blood disorders through medication and lifestyle modifications.
• Vaccinations: Patients with spleen dysfunction or those undergoing spleen removal require vaccines against pneumococcus, meningococcus, and Haemophilus influenzae to prevent severe infections.
• Observation: In cases of mild, asymptomatic splenomegaly, regular monitoring may be recommended without immediate treatment.

Surgical Treatment

• Splenectomy (Spleen Removal): Indicated for severe hypersplenism, traumatic rupture, or some cancers involving the spleen. It can be performed laparoscopically or through open surgery.
• Embolization: In selected cases, partial spleen embolization may be used to reduce spleen size while preserving some immune function.

Prognosis

The prognosis for spleen-related conditions depends on the underlying cause and the effectiveness of treatment. Many cases of splenomegaly caused by infections resolve fully with appropriate treatment. Autoimmune or blood disorders may require long-term management but can often be well-controlled.

For patients undergoing splenectomy, the long-term outlook is generally good, though they become more susceptible to certain infections. With proper vaccinations and preventive care, this risk can be significantly reduced.

In cases of cancer or severe systemic diseases affecting the spleen, prognosis varies depending on the stage and response to therapy. Early diagnosis and treatment lead to better outcomes in most cases. Regular medical follow-up is essential to monitor for complications and manage overall health.