Ultrasound splenomegaly syndrome. Causes of enlarged spleen in adults, diagnosis and possible consequences. Which doctor should I contact if my spleen is enlarged?

The spleen is a fist-sized organ located on the left side of the ribcage. Due to various diseases, it can increase in size - this phenomenon is called splenomegaly. What it is, how to treat this disorder - we talk about this in detail in this publication.

Splenomegaly - what is it?

Splenomegaly is an enlargement of the spleen. Pathology can be caused by many reasons and occurs in both adults and children. The spleen plays an important role in fighting infections. Leukocytes are formed in it, which are the first to begin destroying pathogens that have entered the body.

Other functions of the spleen:

Filtration and destruction of damaged and old blood cells;
Production of a reserve amount of red blood cells, which are used by the body when necessary, for example, during blood loss;
Protein synthesis;
Storage of a supply of blood cells (platelets, erythrocytes, leukocytes);
Destruction of insoluble compounds resulting from burns.

Splenomegaly is considered as a symptom of a particular disease and is accompanied by a violation of each of these important processes. For example, the spleen begins to filter out not only damaged, but also normal blood cells, which, accumulating in it, interfere with the proper functioning of the organ.

Causes of splenomegaly

There are many diseases that cause splenomegaly. This phenomenon may be temporary, depending on the effectiveness of treatment of the underlying disease. In addition to pathologies of the spleen - tumors, cysts, organ infarctions, abscesses - with splenomegaly the causes may be as follows:

acute and chronic bacterial infections - brucellosis;
viral pathologies – hepatitis, rubella, measles;
mycoses - blastomycosis, histoplasmosis and other fungal infections of the blood and internal organs;
protozoal infections – leishmaniasis, ;
helminthiases – schistosomiasis;
circulatory disorders - development, Pick's cirrhosis;
systemic diseases of the hematopoietic organs - leukemia, lymphoma, myelofibrosis;
pathologies associated with metabolic disorders - glycogenosis, Wilson's disease;
autoimmune diseases in which the immune system mistakes body cells for foreign ones - rheumatoid arthritis, systemic lupus erythematosus.

The cause of the development of splenomegaly is also anemia of various types - pernicious, hemolytic and others.

Splenomegaly in children

In childhood, the spleen is sometimes slightly enlarged without any disturbances in the child’s body. This is a physiological norm and is observed in a third of newborns, 15% of six-month-old children and a small proportion of primary schoolchildren.

The norms for the maximum size of the spleen in children are presented in the table:

Age, years	1	2	3	4	5	6	7
Width/length, mm	65/25	72/34	79/37	84/39	88/39	91/41	96/41

8	9	10	11	12	13	14	15	16
100/43	102/43	103/44	108/44	113/45	118/46	120/48	120/49	121/51

Splenomegaly in children is a symptom of the same diseases as in adults; there are no differences.

There are two forms of splenomegaly:

Inflammatory, which occurs when organ tissues become inflamed (bacterial, protozoal, viral infections, helminthic infestations, abscesses and infarction);
Non-inflammatory, caused by disorders not associated with infections and inflammation (with anemia, systemic, autoimmune diseases).

Moderate splenomegaly is also distinguished when the length of the spleen does not exceed 20 cm, and severe - 21 cm or more.

pain on the left under the ribs - one of the symptoms, photo

Since an enlarged spleen is a manifestation of a particular disease, it has no general symptoms. There are only signs of splenomegaly associated with its two forms.

1 - manifestations of inflammation:

high temperature, up to 40°C;
sharp cutting pain in the left hypochondrium;
mild nausea;
sometimes vomiting and diarrhea;
palpable pain on palpation of the left side under the ribs.

2 - symptoms of splenomegaly without inflammation:

pulling, aching, unexpressed;
body temperature remains normal, and if it increases, then to a maximum of 37.5 °C;
When palpating the side, the pain is not severe.

Diagnosis of splenomegaly

The primary diagnosis of splenomegaly is carried out by palpation of the abdomen in the left hypochondrium. To clarify the diagnosis, the following studies are indicated:

General clinical blood test to determine the number of leukocytes, red blood cells and platelets;
Taking liver samples;
and computed tomography;
ultrasound examination;
Bone marrow biopsy, which provides more complete information about the state of blood cells.

A puncture biopsy of the spleen is performed extremely rarely, as it carries a risk of bleeding.

Treatment tactics for splenomegaly

Therapy for splenomegaly in adults and children consists of identifying and eliminating the pathology that provoked the enlargement of this organ. Depending on the specific disease, the following drugs are prescribed:

Surgical removal of an enlarged spleen (splenectomy) is indicated if conservative treatment of splenomegaly is unsuccessful.

Surgery also necessary for:

hypersplenism, when healthy blood cells are destroyed in the spleen;
thrombocytopenic purpura;
Banti syndrome;
hemolytic jaundice.

The operation is often performed through laparoscopy - through small incisions. As a result of the removal of the spleen, the body's ability to resist infections is reduced. In this regard, antibiotics are required before and after splenectomy. Vaccinations are also carried out against meningitis, Haemophilus influenzae, pneumococcal infections and influenza.

Complications

Possible complications of splenomegaly include:

Hypersplenism is a lack of formed elements in the blood due to their breakdown in the spleen (leukopenia, anemia, thrombocytopenia);
Organ rupture;
Worsening of the pathology, against the background of which the spleen was enlarged.

Splenomegaly - which doctor should I contact?

Since the spleen is a hematopoietic organ, its pathologies are treated by a hematologist. But since pain in the left side under the ribs and other manifestations of splenomegaly can be the result of various diseases, then first you should make an appointment with a therapist, describing to him all the symptoms in detail.

After examining and studying the results of basic tests, he will refer you to a more specialized specialist for further diagnosis and treatment.

Splenomegaly is any, even slight, increase in size of the spleen and is not an independent disease. This is a nonspecific condition characteristic of a variety of diseases.

The spleen is a parenchymal single organ in the abdominal cavity, located in the left hypochondrium, connected by ligaments to the diaphragm, colon, stomach and liver. Although it is not a vital organ and one can live without it, it performs a number of important immune and non-immune functions.

Functions of the spleen

Creates a reserve (depot) of blood cells.
Controls the condition of blood cells and destroys old and damaged red blood cells.
It is where the final maturation of some fractions of lymphocytes and macrophages occurs.
Due to the presence of macrophages in the tissues of the spleen, it performs the functions of phagocytosis (capture and destruction of bacteria by macrophages).

The spleen is bean-shaped and its size depends on the age and height of the person. Normal sizes at the age of 1 year are 5-6 cm by 1.5 - 2.5 cm, by 5 years it measures 6-7 cm by 4.1 cm. In adolescence it increases to 8.5 -12 cm by 3 ,1 -4.8 cm. And for an adult, dimensions of 9.1 - 12.1 cm by 3.5 by 5.1 cm are considered normal. Some enlargement of the spleen in children, up to primary school age, is not a pathology. Adults may also have mild splenomegaly due to various physiological reasons. Therefore, acceptable criteria for organ enlargement were established: for a newborn it is 50% of the normal size, for a 6-month-old baby it is 30%, and for a primary school child and teenager it is only 3%. In an adult, on average, the spleen weighs 150–200 grams; a weight of more than 200 indicates splenomegaly.

With a condition such as splenomegaly, the causes in adults are exactly the same as in children. Often at the conclusion of the ultrasound examination it can be seen that moderate splenomegaly is present. What this is can be seen from the classification presented below.

According to the degree of enlargement of the spleen, it happens :

Moderate, in this case the maximum size in length is no more than 20 cm;
Severe splenomegaly, more than 20 cm in length, can reach gigantic proportions.

Classification of splenomegaly

Due to their occurrence, there are two main forms:

Inflammatory splenomegaly

Viral infections.

Infectious mononucleosis - more often than other viruses causes splenomegaly, the spleen is enlarged and dense on palpation.

Acute viral hepatitis. First of all, the liver is affected, then the spleen, symptoms of general intoxication and jaundice are noted.

Splenomegaly can also occur with measles, rubella and cat scratch disease.

Bacterial infections. With a widespread bacterial infection or sepsis, the spleen may enlarge due to a pronounced immune response, and an abscess (purulent inflammation) of the spleen may develop.

Salmonellosis. Severe intoxication leads to the fact that the organ ceases to cope with its functions and increases in size.

Miliary tuberculosis with damage to internal organs. Leads to widespread lymphadenopathy, splenomegaly, and general intoxication.

Syphilis. The chronic advanced form with damage to internal organs also leads to an enlarged spleen.

Defeat by protozoa.

Leishmaniasis, or more precisely its visceral form, which is characterized by damage to internal organs. With this disease, the spleen can reach very large sizes, so pronounced and adults should always be tested for leishmaniasis.

Malaria - an enlarged spleen with this disease is especially common in young children and newborns with congenital malaria. Such children do not have clear temperature peaks characteristic of the disease and splenomegaly often becomes the only diagnostic criterion.

Toxoplasmosis. Splenomegaly occurs in cases of intrauterine infection of the fetus. In adults with acquired toxoplasmosis, an enlarged spleen is rare.

Various fungal infections.

Histoplasmosis, common form. In Russia and the CIS countries it is quite rare, however, in the presence of splenomegaly, fever, enlargement of the liver and lymph nodes, it is necessary to do tests for histoplasmosis.

Blastomycosis. A severe fungal infection that affects the liver and spleen.

Worm infestations, such as ascariasis, echinococcosis, trichinosis can also cause an enlarged spleen.

Non-inflammatory splenomegaly

This condition is a sign of a large number of diseases not associated with infections.
Autoimmune diseases. These are diseases that arise due to a malfunction in the immune system, as a result of which antibodies are produced against the body's own cells (rheumatoid arthritis, systemic lupus erythematosus, Addison's disease, periarteritis nodosa).
Anemia in which red blood cells are destroyed. Congenital pathologies such as spherocytosis, thalassemia, sickle cell anemia and other hemoglobin pathologies.
Storage diseases can also lead to an increase in the size of the spleen. , histiocytosis, Gaucher disease.
Splenomegaly can occur with diseases of the liver and circulatory system. Liver cirrhosis, chronic heart failure, portal or splenic vein thrombosis.
Malignant diseases. Macroglobulinemia, lymphomas and some types of leukemia, tumor metastases.
Other causes: splenic cyst, abscess, rupture.

Symptoms of splenomegaly

With minor and moderate splenomegaly, the symptoms of the underlying disease come to the fore, and an enlarged spleen will be a finding during examination. For anemia and thrombocytopenia this is:

Fatigue, weakness, apathy;
Pale skin, bruising;
There may be weight loss;
Tachycardia and heart murmurs;
Sleep disorders;
Decreased performance;
Weakening of the immune system;

With viral and bacterial infections, first of all, a general intoxication syndrome (weakness, fever, headache) and symptoms characteristic of a specific infection are manifested.

With a pronounced increase, there will be symptoms associated with compression of the abdominal organs by the enlarged spleen. The signs of splenomegaly in an adult are practically no different from those in children.

Pressing and aching pain in the left hypochondrium;
Feeling of discomfort or foreign body in the left hypochondrium;
Flatulence;
Constipation;
Decreased appetite, feeling of rapid satiety (associated with pressure on the stomach wall).

Diagnosis of splenomegaly

Primary diagnosis consists of examining the patient and palpating the spleen. With strong magnification, it can protrude through the anterior abdominal wall. By palpation (feeling), the doctor can quite easily determine whether the spleen is enlarged or not.

At the second stage of the examination, ultrasound of the abdominal cavity is used, which can reveal:

concomitant enlargement of the liver (hepatolienal syndrome);
possible cirrhosis of the liver, tumors, cysts and abscesses of the spleen;
helminthic invasion of the liver (echinococcosis).

Abdominal MRI and CT (computed tomography) are also used.

Splenomegaly is a pathological condition characterized by an enlarged spleen. This is not an independent disease, but an important symptom of another disease. Sometimes splenomegaly can occur simultaneously with liver enlargement. In this case, they talk about the progression of hepatosplenomegaly. Next, we will look in detail at what kind of disease this is, what the causes and symptoms are, as well as how to treat splenomegaly in adults.

What is splenomegaly

Splenomegaly is an abnormal enlargement of the spleen associated with the occurrence of any pathological process in the body and is not an independent disease. In simple words, this is a symptom of an enlarged spleen. The symptom itself is not dangerous, but in any case, an in-depth diagnosis aimed at identifying the causes is required.

Normally, the spleen cannot be felt during palpation. In an adult, the functions of the spleen are as follows:

Participation in the formation of immunity is filtering out harmful bacteria and viruses, retaining blood antigens and creating antibodies that are so important for protecting the body from diseases.
Removal from the general bloodstream, absorption and neutralization of old red blood cells.
Accumulation of spare blood and saturation of the body with it in emergency situations. With significant blood loss, the spleen releases a supply of platelets and red blood cells into the general blood stream, thus saturating the body with the necessary oxygen.

Causes of splenomegaly

As already mentioned, splenomegaly is caused by another disease in the body - from cancer to common inflammatory infections. In 70% of cases, the cause of an enlarged spleen is cirrhosis of the liver. Other possible causes of an enlarged spleen:

It is worth noting that in hematopoietic pathologies and autoimmune diseases, characteristic splenomegaly occurs in the early stages of the disease. The organ quickly and greatly increases in size and is easily detected even when independently palpating the epigastric region.

Splenomegaly can develop in people of any age, race, or gender, but the following are high-risk groups:

Children and young people infected with the virus.
Residents and visitors to areas where malaria is endemic.
Suffering from Gaucher disease, Niemann-Pick disease and some other hereditary metabolic diseases affecting the condition of the liver and spleen.

Symptoms and signs of the disease

The spleen may become enlarged while performing its normal functions in response to another disease. Some infections and diseases that affect blood cells increase blood flow to the spleen. Additionally, diseases affecting the spleen are common causes of enlargement. Splenomegaly is not always an abnormal condition, and the size of the spleen does not necessarily indicate a dysfunction.

In the photo on the left there is a normal spleen, and on the right there is splenomegaly

Since splenomegaly is a consequence of many different diseases, there are no specific symptoms.

Possible symptoms of splenomegaly:

Infectious and inflammatory splenomegaly can be manifested by fever, pain in the left hypochondrium, as well as nausea, vomiting and stool disorder.
As for non-inflammatory forms of splenomegaly, they can be manifested by a slight increase in temperature, mild pain in the left hypochondrium and slight pain when palpating the left hypochondrium.
Other clinical signs, as a rule, depend on the manifestations of the underlying disease; sometimes pain is observed on the left side of the spleen.

Unfortunately, splenomegaly can be asymptomatic for a long time. If an enlarged spleen is detected, it is necessary to identify and eliminate the causative disease against which the spleen enlarges.

How is splenomegaly diagnosed in adults?

If heaviness appears in the left hypochondrium and splenomegaly is suspected, you should consult a therapist who will determine the primary diagnosis. Depending on the cause of the enlarged spleen, further treatment is carried out by a hematologist, infectious disease specialist, endocrinologist, or rheumatologist.

Diagnostics:

When diagnosing a disease, information is initially collected from the patient’s words. It is necessary to find out what disease led to the enlargement of the spleen and what the patient’s complaints are. The doctor usually finds out how long these symptoms have been bothering the person and what he associates with their occurrence. The doctor also needs to know whether the patient visited exotic countries before the onset of the disease, whether there were changes in the general condition, whether the patient smokes or abuses alcohol.
Laboratory research methods include clinical and biochemical blood tests, coagulogram, general urine test, coprogram, stool test for the presence of , as well as bacterial blood culture.
Ultrasound of the spleen. The purpose of an ultrasound examination is to confirm or refute the presence of injuries to the organ being examined, neoplasms, inflammatory processes and developmental anomalies
If it is necessary to confirm splenomegaly in cases of questionable results after a preliminary examination, ultrasound is the method of choice due to its high accuracy and low cost. CT and MRI can provide more detailed images of the organ. MRI is particularly useful in identifying portal thrombosis or splenic vein thrombosis. Radioisotope testing is a highly accurate diagnostic method that can identify additional details of splenic tissue, but the method is very expensive and difficult to perform.

If the patient does not feel sick, there are no symptoms of illness other than those due to splenomegaly, and there is no risk of infection, there is no need for a wide range of tests other than a complete blood count, peripheral blood smear, liver function tests, abdominal CT scan cavity and ultrasound of the spleen.

Treatment

Treatment of splenomegaly, as a rule, comes down to eliminating the causative disease that caused the enlargement of the spleen. Therapy can be carried out using antibacterial drugs (if splenomegaly has a bacterial etiology). Treatment of tumors and diseases of the hematopoietic system consists of the use of antitumor drugs. Hormonal drugs and vitamin therapy are widely used.

Often, in parallel with the treatment of the underlying disease, specialists carry out a number of measures to improve the patient’s condition and treat splenomegaly. Such procedures include the following:

leukocyte transfusion;
platelet transfusion;
treatment of the patient with glucocorticoids (in this case, the drug “Prednisolone” is prescribed in the amount of 20-40 milligrams per day for 4-6 months);
removal of an enlarged organ or splenectomy (prescribed if conservative treatment does not bring results).

Nutrition

The diet for spleen disease is identical in content to the nutritional method for people suffering from liver disease. The diet itself is considered one of the most effective measures to restore the functionality of the affected organ and helps prevent relapses and new diseases.

To help perform functions, you need to eat:

meat (beef, chicken, pork, rabbit, crayfish, crabs), fatty fish (preferably sea), liver;
vegetables and legumes (beets, cabbage, carrots, bell peppers, pumpkin, turnips, tomatoes, beans, green peas, lentils);
porridge (especially buckwheat - it has a high iron content);
fruits and berries (all citrus fruits, pomegranate, avocados, bananas, apples, currants, wigs, blueberries);
greens, ginger root;
drink drinks: green tea (especially with ginger), decoctions of rose hips, hawthorn, freshly squeezed juices from the above vegetables and fruits, cranberry juice.

The list of prohibited products includes:

fried, spicy foods;
baked goods, fresh white bread;
any types of mushrooms;
coffee;
chocolate products;
alcohol;
broths;
seasonings, herbs, spices, mustard, vinegar, sauces, mayonnaise;
fish caviar and canned food;
salo;
eggs;
carbonated drinks.

In general, a diagnosis such as splenomegaly is not as dangerous as its underlying disease. It should be especially noted that in modern medical practice there have been many cases where even a greatly enlarged spleen returned to its normal size after combination therapy for the underlying disease.

The spleen is the organ responsible for numerous vital functions.

In particular, the spleen takes part in the formation of the body’s immune defense (it produces lymphocytes, cells that fight viruses and infections); the spleen is necessary for the normal process of hematopoiesis and the accumulation of useful substances in the body, for example, iron.

However, like any other organ, the spleen is susceptible to various types of inflammation and pathological processes, to which the organ reacts by increasing its size. As a result, a phenomenon called splenomegaly occurs. We will talk about the causes of splenomegaly in children in the article.

Characteristics of the pathology

Splenomegaly - what is it?

Splenomegaly is a disease in which the size of the spleen increases significantly. At the same time, pathology is not considered an independent disease, but develops against the background of other diseases, being only their symptom.

Many of these diseases are very dangerous, so an increase in the size of the spleen should be alarming.

The disease cannot always be recognized; often a person does not even suspect that pathological processes are occurring in his body. However, illness needs treatment, and the sooner it is carried out, the better.

Detecting an increase in the size of the spleen (especially if this deviation is insignificant) is very problematic, because the organ cannot always be felt by palpation. This can only be done in infants or children with low body weight. Therefore very it is important to recognize in time symptoms of splenomegaly.

We can talk about splenomegaly if the weight and size of the spleen deviate significantly from the norm (2 times or more), or if this organ can be palpated by palpation (with the exception of newborn children).

ICD 10 code- R16.1.

Causes

Splenomegaly in a child develops as a result of a wide variety of pathological processes occurring in the body.

To the number causes of the disease can be attributed:

Cancer and other blood diseases.
Liver pathologies (for example, various types).
Inflammatory processes in the body.
Systemic diseases accompanied by a persistent decrease in immunity.
Lipid metabolism disorder (Gaucher disease).
Thrombosis, blood flow disorders.
Infectious diseases in chronic form.
Excessive levels of vitamin A in the body.

Normal size of the spleen

Indicators in each specific case may deviate from the presented indicators. This is also considered a variant of the norm, but only if these deviations are insignificant.

If the size of the organ exceeds normal values by 2 or more times, we are talking about pathology.

The presence of a disease can also be said if the organ has a pointed edge or an excessively dense structure.

Age (years)	Length (mm.)	Width (mm.)

Classification and severity

Depending on the severity of symptoms and the size of the spleen, they are divided into 4 degrees of severity of splenomegaly:

Based on the reasons that provoke and accompany splenomegaly, they distinguish inflammatory and non-inflammatory form illness.

Symptoms and signs

Splenomegaly is characterized by numerous manifestations. At the same time, depending on the provoking factors, clinical picture may vary:

Complications and consequences

With splenomegaly, the composition of the blood changes. The spleen, increasing in size, begins to process red blood cells at a more active pace, which over time may lead to severe anemia.

Increasing the rate of processing of platelets and leukocytes weakens the child’s immune system, as a result of which he becomes more sensitive to the action of pathogenic microflora.

Diagnostics

Detection of the disease is carried out in several stages.

First of all, the patient is examined and interviewed, and palpation spleen.

How to treat a baby? Today there is several treatment methods, such as drug therapy, which is often supplemented by the use of traditional medicine, diet therapy, and surgery.

Surgical intervention

Surgery is performed only if indicated, or if conservative methods turned out to be ineffective.

Indications to the operation are:

gigantic size of the organ;
severe anemia, which leads to massive death of red blood cells and a significant change in blood composition;
the presence of large cystic formations or malignant tumors in the spleen;
blockage of large blood vessels of the organ;
risk of developing splenic rupture and hemorrhage;
leukemia, Gaucher disease.

There are 2 types of operation: open splenectomy(a large incision is made on the left side of the child’s body, through which the doctor removes the affected organ, after which the wound is sutured) and laparoscopy(the operation is performed using a laparoscope equipped with a miniature camera. The instrument is inserted through a small incision in the abdominal cavity).

To treat splenomegaly in children, surgery is used extremely rarely, only in necessary cases, and the second option of surgery is most often used, since it is considered the least traumatic.

Medication

To eliminate the manifestations of pathology and normalize the condition of the spleen, the child is prescribed taking medications, such as:

antibiotics;
antiviral drugs;
means for combating tumor formations;
anthelmintics;
hormonal drugs;
antifungal medications;
vitamin complexes for general strengthening of the body.

Choosing one drug or another carried out by a doctor, only after determining the cause of the disease and its form.

This determines the effectiveness of the treatment.

Traditional medicine

To treat splenomegaly in a child, along with medications, traditional methods of treatment are also used, for example, the following:

Infusion of shepherd's purse. 1 tbsp. dry herbs, pour a glass of boiling water, leave for 20 minutes, strain. The child should take the infusion 3 times a day, 1-2 tbsp.
Nettle leaves, strings, strawberries and violet flowers(dried or fresh) take in equal proportions (1 tablespoon each) and pour a liter of boiling water. After this, the product must be wrapped warmly, put in a dark place and left until the infusion has cooled. It is recommended to take the product half a glass 2 times a day.

If a child has any disorders of the gastrointestinal tract, nettle leaves must be excluded from the recipe.

Diet

A child suffering from splenomegaly must adhere to a certain diet. It is necessary to consume sufficient quantities of such foods as:

But sweets, fatty, fried foods, foods that are difficult to digest. Best exclude.

Forecast

Since the cause of splenomegaly in a child can be a variety of diseases, many of which are extremely dangerous, the prognosis for recovery is ambiguous.

It all depends on the cause of the pathology. But, in any case, timely treatment will increase the child’s chances of successful recovery.

Prevention

To prevent the development of the disease, it is necessary to protect the child from diseases that can cause an increase in the size of the spleen.

To prevent such conditions it is necessary:

Monitor your diet and fluid intake. Meals should be fractional; only healthy foods should be included in the diet. The child should drink enough liquid, and the drinks should not be too cold or hot.
Accustom your child to an active lifestyle. This could be sports activities, or just active games in the fresh air.
Important avoid hypothermia, put on the child comfortable clothes that are suitable for the weather and do not compress the abdominal area.

Splenomegaly - enlargement of the spleen, is not an independent disease, but acts as a symptom characteristic of many pathological processes occurring in the body.

It is quite problematic to detect a problem at an early stage of its development, so it is necessary to pay attention to the manifestations of the disease, and, having noticed them, show the child to the doctor as soon as possible.

About what function does the spleen perform in the body?, you can find out from the video:

We kindly ask you not to self-medicate. Make an appointment with a doctor!

Splenomegaly (from the Greek splen “spleen”, megas “large”) is a term meaning an enlarged spleen. Splenomegaly is usually spoken of when the mass of this organ is more than 600 g. In this case, it can be felt in the left half of the abdomen in the hypochondrium.
The reasons for the enlargement of the spleen are varied, since this organ performs many different functions in the body. Therefore, the causes of splenomegaly are usually classified according to the mechanisms of their development.

The following main types of splenomegaly are distinguished:

“working” hypertrophy in response to the systemic action of toxins associated with the immune response to infection;
hypertrophy associated with increased breakdown of blood cells in the spleen;
enlargement of the spleen associated with stagnation of venous blood in it;
increased formation of pathological blood cells in tumors of the blood and bone marrow;
splenomegaly of mixed origin.

Reasons

On the left is a normal-sized spleen, on the right is an enlarged one.

Enlarged spleen during infectious and toxic processes

When antigens enter the body from the external environment or under the influence of internal toxic factors, an intense immune process develops. The spleen actively participates in it, and its blood supply and the mass of cells contained in it increase.
An enlarged spleen is characteristic of many inflammatory, necrotic processes in the body. It occurs in acute infections (infectious mononucleosis, hepatitis, typhus, tularemia, sepsis, infective endocarditis). Splenomegaly is characteristic of chronic infections such as tuberculosis and malaria. It occurs in toxoplasmosis.

Enlarged spleen with increased breakdown of blood cells

The physiological process of destruction of outdated blood cells (erythrocytes, platelets, leukocytes) occurs in the spleen. In blood diseases accompanied by increased destruction of these formed elements, there is a natural increase in the size of the spleen.
This mechanism of splenomegaly is characteristic of a number of anemias accompanied by the breakdown of red blood cells (so-called hemolytic anemia). These include congenital spherocytosis, autoimmune hemolytic anemia, and sickle cell anemia.
Autoimmune diseases with destruction of white blood cells (neutropenia) and platelets () can also sometimes be accompanied by an enlarged spleen.
With chronic hemodialysis, instability of blood cell membranes develops; they are easily destroyed. Therefore, during hemodialysis, the development of splenomegaly is also possible.

Stagnation of venous blood in the spleen

The venous network is well developed in the spleen. Therefore, when the outflow of venous blood from it is disrupted, it increases. When blood accumulates in this organ, vascular tissue begins to grow and the number of red blood cells increases. The so-called Banti disease develops.
Stagnation of blood in the spleen can occur due to various processes leading to increased pressure in the portal, splenic, and hepatic veins. These large veins can be compressed, for example, by an abdominal tumor. Their lumen may be blocked by a thrombus. Liver cirrhosis leads to increased venous pressure. Severe cases with severe edema are also accompanied by stagnation of blood in the spleen and its enlargement.

Enlarged spleen in blood diseases

In the embryonic period, the spleen is a hematopoietic organ. Therefore, in case of blood diseases, new foci of hematopoiesis and metastases may appear. Sometimes primary tumors of the spleen occur.
Splenomegaly is accompanied by such serious diseases as subleukemic myelosis, chronic myeloid leukemia, chronic lymphocytic leukemia, lymphogranulomatosis, lymphoblastic leukemia, multiple myeloma, polycythemia vera, essential thrombocythemia, etc.

Enlarged spleen of mixed origin

Symptoms of splenomegaly

Splenomegaly may be accompanied by pain in the left hypochondrium, bloating, and a tendency to constipation.

Symptoms of an enlarged spleen occur when it is of significant size and are associated with stretching of its capsule and compression of surrounding organs. Therefore, signs of an enlarged spleen may be aching pain in the left hypochondrium, constipation, and bloating. When the stomach is compressed, a feeling of early satiety and lack of appetite occurs, as well as signs of reflux of stomach contents into the esophagus ().
An enlarged spleen is accompanied by signs of the disease that caused it. This may be weakness, sweating, fever, bleeding, weight loss, etc.

Treatment of splenomegaly

Treatment of splenomegaly is aimed at treating the underlying disease (treatment of an infectious-inflammatory process, reducing pressure in the veins of the abdominal cavity, chemotherapy for tumors, etc.).
Sometimes surgical removal of an enlarged spleen () is indicated, for example, with idiopathic thrombocytopenic purpura. In this disease, removal of the spleen leads to a rapid restoration of platelet levels in the blood.
Splenectomy is also performed for Gaucher disease, hairy cell leukemia, and thalassemia.
After such an operation, a person’s susceptibility to pneumococcus, meningococcus and Haemophilus influenzae increases, so such patients are vaccinated against the corresponding microorganisms.

Which doctor should I contact?

If heaviness appears in the left hypochondrium, you should consult a therapist who will determine the primary diagnosis. Depending on the cause of the enlarged spleen, further treatment is carried out by a hematologist, infectious disease specialist, endocrinologist, or rheumatologist.