Enlarged Spleen (Splenomegaly)

  • Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: Steven Doerr, MD
    Steven Doerr, MD

    Steven Doerr, MD

    Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.

  • Medical Editor: Bhupinder S. Anand, MBBS, MD, DPHIL (OXON)
    Bhupinder S. Anand, MBBS, MD, DPHIL (OXON)

    Bhupinder S. Anand, MBBS, MD, DPHIL (OXON)

    Dr. Anand received MBBS degree from Medical College Amritsar, University of Punjab. He completed his Internal Medicine residency at the Postgraduate Institute of medical Education and Research, Chandigarh, India. He was trained in the field of Gastroenterology and obtained the DPhil degree. Dr. Anand is board-certified in Internal Medicine and Gastroenterology.

woman with abdominal pain

Enlarged spleen (splenomegaly) facts

  • An enlarged spleen is not normal and occurs as a consequence of another underlying disease.
  • An enlarged spleen is caused by
  • Signs of an enlarged spleen are usually due to underlying causes and may include
  • Symptoms of an enlarged spleen are usually due to the underlying disease or condition causing it; however, those individuals who do have symptoms may experience
    • indigestion and a feeling of fullness because the enlarged spleen can compress the stomach,
    • hiccups because of diaphragm irritation
    • pain in the upper abdomen that may radiate to the back or shoulder blade.
  • Diagnosis of an enlarged spleen is often made by physical examination or by X-rays, CT scan, MRI, or ultrasound
  • Treatment for an enlarged spleen is directed to the care of the underlying condition.
  • Enlarged spleen can be prevented by preventing the underlying illness as best as possible. An enlarged spleen is at risk for damage when it grows beyond the protection given to it by the lower ribs. Activity may need to be restricted to prevent any trauma or damage to the spleen when it is enlarged and vulnerable
  • The prognosis of someone with an enlarged spleen depends upon the underlying condition.

What is the spleen, and what does it do (function)?

The spleen is an important organ in the body that has a variety of responsibilities.

  • It is a major filter of blood, helping remove old and damaged red blood cells, and bacteria.
  • It also is part of the lymphatic system and produces lymphocytes, a type of white blood cell that are a part of the immune system that helps to prevent and fight infection.
  • The spleen also acts as a reservoir for red blood cells and platelets, should the body need them.

Quick GuideDigestive Disorders: Common Misconceptions

Digestive Disorders: Common Misconceptions

Enlarged Spleen Symptoms

Symptoms you may experience with an enlarged spleen include:

  • pressure or pain in the left upper part of your abdomen (near the stomach),
  • feeling full without eating a large meal,
  • or pain your left shoulder blade or shoulder area when taking a deep breath.

What type of pain, and where is the pain located with an enlarged spleen?

  • Because of its location, should it enlarge, the spleen can irritate the diaphragm and cause hiccups and perhaps some pain in the left upper quadrant of the abdomen.
  • Because its location adjacent to the diaphragm, pain from the spleen may radiate to the back and be felt in the shoulder blade.
  • If the enlarged spleen compresses the stomach the person may feel full after eating a small amount, and therefore are unable to eat large meals.

What are other signs and symptoms of an enlarged spleen?

Often, it is not the enlarged spleen itself that causes symptoms, but rather it is the symptoms of the underlying illness that causes splenomegaly.

Where is the spleen, and what does it look like?

The spleen is located in the left upper quadrant of the abdomen, just beneath the diaphragm and next to the stomach. It has a very rich blood supply since it is responsible for filtering blood, and it is protected by the 9th, 10th, and 11th ribs. Normally, it is the size of an orange or a small fist.

The spleen has two types of tissue; the red pulp is responsible for filtering blood, while the white pulp is responsible for its immune function.

Picture of the spleen
Picture of the spleen

What are the causes of an enlarged spleen?

Blood disorders

The spleen will enlarge when it performs more of its duties to filter blood or to manufacture blood cells. Therefore, any disease or condition that damages red blood cells, and requires them to be filtered and removed from the blood stream, will cause the spleen to become larger.

Conditions such as hemolytic anemia, where red blood cells are damaged and broken down (hemolyzed) can cause the spleen to enlarge. Misshapen red blood cells, like those found in sickle cell disease, thalassemia, and spherocytosis, may be damaged when they try to squeeze through small capillary blood vessels. These damaged red blood cells need to be culled from the bloodstream and are filtered out by the spleen.

Decreased blood flow

The spleen will enlarge if there is a decrease in blood flow through the splenic vein. This may cause spleen congestion and enlargement. This situation may be associated with liver disease and portal hypertension. Damage to liver cells makes it difficult for blood to flow normally, and as blood backs up in the portal vein system, it may also affect pressure in the splenic vein. The decreased ability of blood to drain from the spleen causes it to become congested and grow larger. People with congestive heart failure may have an enlarged liver and spleen because of poor blood flow to and from the heart.

Cancer

Leukemia and lymphoma may be associated with abnormal white cells that can invade the spleen and increase its size.

Other cancers can spread or metastasize to the spleen and cause it to enlarge.

Metabolic diseases

Certain metabolic diseases may cause the spleen to enlarge, including Hurler Syndrome, Gaucher disease and Niemann-Pick Disease.

In sarcoidosis and amyloidosis the spleen can be involved and become enlarged with the abnormal protein deposits.

Infection

Some infections may cause splenomegaly including:

Trauma

Trauma, for example, from a car accident, can damage the spleen.

How is the diagnosis of an enlarged spleen made?

An enlarged spleen is most often found on physical examination. Either the health care practitioner is looking for an enlarged spleen because of a diagnosis that has already been made, or it is found incidentally when initially examining a patient (and it then serves as a clue to an underlying diagnosis).

With its location protected beneath the left lower ribs, a normal spleen is usually not felt on physical exam, except in some unusually thin individuals. As it enlarges, the spleen grows from the left upper quadrant of the abdomen towards the umbilicus (the belly button). Sometimes the doctor will ask the patient to roll on their right side to better attempt to feel the spleen. An enlarged spleen may not be felt in obese patients.

On occasion, an enlarged spleen may be diagnosed by plain X-ray, ultrasound, abdominal CT scan, or MRI (magnetic resonance imaging).

Quick GuideDigestive Disorders: Common Misconceptions

Digestive Disorders: Common Misconceptions

What is the treatment for an enlarged spleen?

Because splenomegaly is due to an underlying illness, treatment will depend upon the primary cause. In some situations, removal of the spleen (splenectomy) may be part of the treatment. For example, in hereditary spherocytosis, misshapen red blood cells are filtered from the blood stream causing anemia and an enlarged spleen. Splenectomy limits the number of red blood cells destroyed and helps treat the disease.

What complications are associated with an enlarged spleen?

Perhaps the most important worry with an enlarged spleen is the risk of injury as it grows beyond the protection of the rib cage. A minor injury may cause it to rupture and bleed. Spleen injuries are often treated by observation, but on occasion, the spleen can rupture causing life-threatening internal bleeding requiring surgery for to remove the spleen. This is the reason that teenagers and young adults diagnosed with infectious mononucleosis need to wait until the spleen returns to its normal size, and is protected by the rib cage, before participating in  activities where the enlarged spleen could be damaged.

All types of blood cells may become trapped in a large spleen. Anemia (low red blood cell count) may cause

Thrombocytopenia (low platelet count) may be associated with an increased risk of bleeding.

Leukopenia (low white blood cell count) may be associated with an increased risk of infection.

Should the spleen need to be removed surgically (splenectomy), the risk of certain infections increases, and the patient will need to make certain that their immunizations are up to date, especially against pneumococcus, meningococcus and haemophilus influenzae.

Can an enlarged spleen be prevented?

An enlarged spleen is the consequence of an underlying illnesses, many of which may not be anticipated or prevented.

  • Liver disease due to alcohol abuse, which causes cirrhosis and portal hypertension, can be prevented. With alcohol use, moderation is the key, and excessive drinking has very dangerous consequences both in the short and long term.
  • Certain causes of viral hepatitis (for example, hepatitis B and hepatitis C), which can lead to cirrhosis also can be prevented by avoiding contact with body fluids from infected individuals. Hepatitis B can also be prevented through vaccination.

Finally, certain infectious diseases such as HIV, malaria, tuberculosis, and anaplasmosis can be prevented if the appropriate measures are taken to minimize the risks of acquiring the disease.

What is the prognosis for someone with an enlarged spleen?

Often, the prognosis for an enlarged spleen depends entirely upon the underlying illness. For example, in patients with infectious mononucleosis, the spleen will return to its normal size once the infection resolves.

In some instances, the spleen may need to be removed and the risk of infection may increase. In other cases, the spleen will remain enlarged and leave the patient at an increased risk for bleeding, spleen rupture, and infection.

Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care

REFERENCES:

Hillman,R, etal. "Hematology in Clinical Practice." 5th edition. McGraw Hill Education. 2010

Rakel RE, Rakel DR. Textbook of Family Medicine. 8th edition. Saunders. 2011.

Quick GuideDigestive Disorders: Common Misconceptions

Digestive Disorders: Common Misconceptions

Subscribe to MedicineNet's General Health Newsletter

By clicking Submit, I agree to the MedicineNet's Terms & Conditions & Privacy Policy and understand that I may opt out of MedicineNet's subscriptions at any time.

Reviewed on 10/12/2016
References
Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care

REFERENCES:

Hillman,R, etal. "Hematology in Clinical Practice." 5th edition. McGraw Hill Education. 2010

Rakel RE, Rakel DR. Textbook of Family Medicine. 8th edition. Saunders. 2011.

Health Solutions From Our Sponsors