Enlarged Spleen (Splenomegaly) (cont.)
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.
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
In this Article
- What is an enlarged spleen?
- What are the causes of an enlarged spleen?
- What are the symptoms of an enlarged spleen?
- When should I seek medical care for an enlarged spleen?
- How is enlarged spleen diagnosed?
- What is the treatment for an enlarged spleen?
- What are the complications of an enlarged spleen?
- Can an enlarged spleen be prevented?
- What is the outlook (prognosis) for an enlarged spleen?
- Enlarged Spleen At A Glance
How is an enlarged spleen diagnosed?
Most often an enlarged spleen is found incidentally on physical examination by the health care practitioner. The spleen usually is small enough to hide underneath the left rib cage in the upper abdomen. The enlarged spleen tip can be felt in the left upper quadrant of the abdomen and as it continues to enlarge the tip moves towards the right lower quadrant. In some thin people, the spleen can be felt in the abdomen but is normal in size. An enlarged spleen measures about 12 to 20 cm (4.5 to 8 inches) in any dimension while a spleen greater than 20 cm (8 inches) is considered severe enlargement.
If there is concern that the spleen is enlarged, blood tests may be considered to assess the cause of the enlargement. Common tests may include a complete blood cell count (CBC) looking for abnormal red or white blood cells, a peripheral smear to assess at the types and shapes of blood cells or a monospot, if the diagnosis of infectious mononucleosis is being considered. Other tests evaluating liver or heart function may be considered if clinically indicated.
An abdominal ultrasound, CT, or MRI of the abdomen may be used to evaluate the size of the spleen and to look for other abnormalities in the abdominal cavity that may be associated with splenomegaly.
What is the treatment for an enlarged spleen?
Treatment for an enlarged spleen is usually directed at the underlying medical condition that resulted in the splenomegaly. Depending on the underlying problem, treatments can be with antibiotics, chemotherapy, or radiation. These treatments are for the underlying disease and may allow the spleen to reduce in size; however, in some cases, the spleen will remain enlarged.
On occasion, the spleen may need to be removed surgically (splenectomy = spleen + ectomy=removal) as part of the disease treatment. For example, in hereditary spherocytosis, removing the spleen prevents the anemia that occurs when the abnormally shaped red blood cells are continually being filtered out and removed from the blood stream.
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