Splenomegaly

Splenomegaly called an acute or chronic enlargement of the spleen (Greek: Splen ). The weight of the spleen thus exceeds the adult usually 350 g or dimensions exceed the normal values ​​( max. width 4 cm, transverse diameter 7 cm, length 11 cm → Bookmarks number " 4711" Eau de Cologne ). It is not a separate disease, but a finding that can have various causes, according to the various tasks of the spleen. In most cases there is a disease that is not confined to the spleen. The most common cause of splenomegaly are infectious diseases such as mononucleosis, cytomegalovirus infection or sepsis, which occurs when bacteria enter the bloodstream. In addition, in rheumatic diseases or storage diseases such as haemochromatosis may arise splenomegaly. In addition to these diseases, a blood congestion in front of the liver causes an enlargement of the spleen, since the blood, is now backing up from the gastrointestinal tract, which was supposed to flow through the portal vein through the liver to the spleen. The diseases that can cause such congestion are very varied and include, for example, cirrhosis of the liver as well as inflammation of the pancreas ( pancreatitis) and the liver ( hepatitis). Frequently Splenomagalie is also a sign of blood disorders, such as forms of leukemia or Hodgkin's disease. Especially with malignant blood diseases, the spleen is often associated with enlargement of the liver ( hepatosplenomegaly ). Finally, a tumor in the spleen may lead to an enlarged spleen.

Does the spleen increased by a disease significantly in volume, it may cause a gain of function, which is called in the jargon hypersplenism. That is, the spleen stores too many red and white blood cells and platelets and also degrades too many, so that too few of them are with the life in the blood.

The spleen and their functions

The spleen is located in the upper abdomen on the top left behind the stomach. It measures about 4 × 7 × 11 cm. It takes two main tasks for the blood system: it builds red blood cells in the red pulp from when they have become old and therefore rigid or inoperable. It further has an immunological function: Part of lymphocytes that belong to the white blood cells that are located in the spleen in the white pulp. You are responsible for defense against infection and are activated to attack as bacteria or viruses. Flowing through the spleen, blood is filtered in two ways.

Also in the spleen, a large amount of platelets for blood clotting, and red blood cells are stored.

Diseases

Disorders which can cause, inter alia, splenomegaly:

• Hematologic and lymphatic reason Erkankungen (eg, leukemia, polycythemia vera, Essential Thrombocythemia, lymphoma, Castleman's disease, and others)
• Leukemias
• Acute and chronic infections (eg EBV or malaria)
• Rheumatologic diseases reason
• Acute and chronic blood backflow from the portal vein (eg, portal hypertension, splenic vein thrombosis, right heart failure )
• Storage diseases (eg, Gaucher's disease )
• Sarcoidosis
• Amyloidosis
• Splenic abscess (see Abscess )
• Hematoma
• Hemangioma
• Littoralzellangiom
• Metastases
• Cysts
• Echinococcosis
• Sarcoma
• Erythropoietic protoporphyria
• Mononucleosis
• Brucellosis
• Spherical cell anemia

Diagnostics

First, the doctor will do a physical examination, where he scans including the stomach, to search for painful spots or just enlarged internal organs. A normal spleen is not palpable. However, if it increases, it is significantly below the left costal arch when the patient inhales deeply.

Then it can be determined accurately by means of an ultrasound examination ( sonography ) their size. Splenomegaly can be secured using an ultrasound scan and other imaging methods (CT, MRI). The rest of the diagnosis is based on the presumed underlying disease ( eg, bone marrow biopsy, serology, blood test ).

Based on a sample of blood is examined in the laboratory, if the white and red blood cells and platelets are reduced. Has the enlargement of the spleen led to store too many blood cells and breaks down, you can recognize this in the blood sample by counting the cells and compared with the normally existing number.

Even safer to leave splenomegaly and especially the one described in the introduction hypersplenism by a so-called scintigraphy diagnose. In this method, the blood cells are " stained " with a non-harmful to the body, slightly radioactive substance and can be made ​​visible on a screen. The more blood cells thus accumulate at a hypersplenism in the spleen, the darker the spleen is shown on the screen.

Symptoms

If the spleen is so large that it presses because of their location in the body to the stomach or other organs in the abdomen, it can cause pain in these areas, or nausea and bloating. Pain emanating from the spleen itself, may radiate to the left shoulder.

Often, however, are mainly symptoms present that belong to one of the underlying conditions of splenomegaly. Some common are fever in infections or cancers, painful swollen lymph nodes in the neck during glandular fever or joint pain in rheumatic diseases.

But the consequences of the excessive function of the enlarged spleen give rise to symptoms. Because too many blood cells are broken down, arises as a lack of red blood cells with the typical symptoms of anemia such as pallor, fatigue, and weakness or rapid heartbeat. In the absence of the white blood cells that are responsible for defense against infection, the patient suffering particularly common infectious diseases. The platelets for blood clotting can be reduced, which can lead for example to nosebleeds or frequent minor bleeding of the oral mucosa.

Therapy

Therapy depends as a rule after the underlying disease. There is first the underlying disease therapy, which has led to splenomegaly. If you can not treat any underlying disease and / or if complications of splenomegaly (eg, anemia, thrombocytopenia, granulocytopenia (so-called hypersplenism ), and others), which can not be mastered and still remains the overactivity of the spleen and therefore the changes exist in the blood, there is the possibility of surgical removal of the spleen ( splenectomy ). This can also be in breach of the spleen ( splenic rupture ), as may occur for example when a serious accident, may be necessary. Splenectomy has certain risks. Since the spleen, in addition to the Blutmauserung also functions of the immune system, consists then to infections with bacteria bekapselten ( esp. pneumococcal, meningococcal, and Haemophilus influenzae ) susceptibility. The most important of these are forms of pneumonia, meningitis and inflammation of the ears and sinuses. To prevent severe forms of these diseases, the patient is vaccinated as possible 2-3 weeks before the operation against the causative agent of this disease, the vaccination every 5-10 years must be repeated. It should therefore be vaccinated before splenectomy against these pathogens as far as possible. Especially in children and adolescents infections can by the pathogens mentioned after splenectomy take a severe course ( OPSI syndrome). Since children after splenectomy on infections just described are particularly vulnerable, and this often more severe than in adults, when performed a splenectomy possible only after the age of 6.

Source: http://www.eesom.com/go/Q0JN47IHZIZO4SD3S1DBHNADPF6J9RUE

• Disease in internal medicine
• Spleen