Enlarged Spleen (Splenomegaly): Causes, Symptoms, Treatment and Cost

Splenomegaly, often known as an enlarged spleen, is a disorder where the spleen becomes unusually big.

The little organ known as the spleen, which is situated in the upper left side of the abdomen, is crucial for filtering and storing blood cells.

• Infectious splenomegaly: This type of splenomegaly is caused by infectious agents such as viruses, bacteria or parasites.
• Inflammatory splenomegaly: This type of enlargement is caused by inflammatory conditions, such as rheumatic fever and systemic lupus erythematosus (SLE).
• Vascular splenomegaly: This type of enlargement is due to the accumulation of blood in the spleen, which can be caused by portal hypertension or congestive heart failure.
• Neoplastic splenomegaly: This type is caused by the presence of a tumour or cancer in the spleen.
• Metabolic and endocrine splenomegaly: This type of enlargement can be caused by an underlying metabolic disorder such as amyloidosis or Gaucher's disease, or due to an endocrine disorder such as hyperthyroidism or diabetes mellitus.

• Infectious disease: Many infectious diseases, such as mononucleosis and certain types of hepatitis, can cause an enlarged spleen.
• Metabolic disorders: An enlarged spleen is a recognised symptom of metabolic diseases such Gaucher's disease and Niemann-Pick disease.
• Blood disorders: Blood disorders such as thalassemia and hemolytic anaemia can cause the spleen to become enlarged due to the increased workload it must take on in order to filter out damaged red blood cells.
• Cancer: Certain types of cancer, such as lymphoma and leukaemia, can also cause an enlarged spleen due to the presence of cancerous cells in the organ.
• Other causes: Other causes of splenomegaly include cirrhosis of the liver and certain autoimmune diseases, such as lupus or rheumatoid arthritis.

• Pain or fullness in the upper left abdomen: This is usually the first symptom felt when the spleen becomes enlarged. People may describe a feeling of fullness or pressure in the upper left side of their abdomen, as well as pain when pressure is applied.
• Abdominal swelling: As the spleen enlarges, it can create a noticeable swelling in the abdomen, especially on the left side.
• Feeling of fatigue: Along with other symptoms, feeling exhausted and run down can be a sign of an enlarged spleen.
• Increased urge to urinate: An enlarged spleen can put pressure on the bladder causing frequent urination, even if small amounts are released each time.
• Painful breathing: An enlarged spleen can also cause sharp pains in the chest when taking deep breaths due to pressure on surrounding organs and tissues.
• Loss of appetite: Eating less than usual and not feeling hungry can be a symptom of an enlarged spleen due to lack of space for food to digest properly in the abdomen.

• Avoid Alcohol: Excessive alcohol consumption can lead to an enlarged spleen and other serious health complications. Consequently, it is preferable to consume alcohol in moderation or not at all.
• Treat infections: Bacterial, viral and parasitic infections can cause an enlarged spleen, so treating the infection promptly with antibiotics or antivirals is important in preventing splenomegaly.
• Healthy diet: Eating a nutritious, balanced diet can help keep your immune system strong and reduce your risk of developing an enlarged spleen due to infection.
• Vaccination: Vaccinations are the best way to prevent viral infections that can cause an enlarged spleen, so make sure you get vaccinated according to the recommended schedule.
• Exercise regularly: Frequent exercise may help strengthen your immune system and lower your chances of getting an infection-related enlarged spleen.

• Physical Exam: A physical exam is the first step for diagnosing an enlarged spleen. During the exam, the doctor will feel your abdomen to check if your spleen is enlarged.
• Ultrasound: A non-invasive examination called an ultrasound utilises sound waves to provide a precise picture of your spleen.It’s used to measure the size of your spleen and look for any abnormalities.
• CT scan: A CT scan uses X-rays to create a detailed cross-sectional image of your abdominal organs, including your spleen. This can help determine the size and shape of an enlarged spleen and detect any masses or other abnormalities in or around it.
• MRI scan: An MRI scan produces precise pictures of your organs, including your spleen, using radio waves and a strong magnetic field.It’s used to measure the size of an enlarged spleen and detect any masses or other abnormalities in or around it.
• Blood tests: Your doctor may order blood tests, such as complete blood count (CBC) and liver function tests, to help diagnose an enlarged spleen. These examinations may assist in ruling out other illnesses, such as anaemia or liver disease, that may be the cause of the enlargement.

• Increased risk of infection: An enlarged spleen can trap too many white blood cells and platelets, leaving the body more vulnerable to infections.
• Haemorrhage: The spleen is filled with blood vessels, so if it becomes too large it can rupture, causing internal bleeding.
• Anaemia: An enlarged spleen can trap red blood cells, reducing their numbers in the body and leading to anaemia.
• Abdominal pain: An enlarged spleen can cause pain in the upper left abdomen or shoulder as it presses against other organs or nerves in the area.
• Fatigue: Anaemia and low platelet count associated with an enlarged spleen can cause fatigue due to a lack of oxygen-carrying red blood cells and a lack of clotting factors from platelets.

• Take the herbal remedy Pippali (Piper longum) to strengthen the spleen and reduce inflammation. This powder is available in tablets, capsules, and other forms.
• While obesity may lead to an enlarged spleen, it's important to exercise often to maintain a healthy weight.
• Use hot compresses or massage therapy on the abdomen to help reduce swelling of the spleen and improve blood circulation in the area.
• Drink plenty of fluids throughout the day, particularly warm water with lemon, honey and ginger, which can help promote digestion and flush toxins from the body.
• Practising yoga or pranayama (breathing exercises) can also help reduce stress levels, which may cause an enlarged spleen in some cases.

Foods that are high in protein and low in fat, such as lean meats, fish, poultry, eggs, and legumes, can help reduce the strain on the spleen.

Eating foods that are high in fibre, such as fruits, vegetables, and whole grains, can also help keep the digestive system functioning properly and reduce strain on the spleen.

Drinking plenty of fluids and avoiding dehydration is important for people with splenomegaly as well.

• Foods high in sodium: Eating foods high in sodium can cause an increase in fluid retention, which can cause further enlargement of the spleen.
• Fried foods: Fried foods have more calories and fat per serving than other forms of food. Consuming excessive amounts of these foods may increase weight and put stress on the spleen, which might cause additional enlargement.
• Processed meats: Processed meats are heavy in salt and saturated fat, which may promote fluid retention and cause weight gain, which can exacerbate an enlarge spleen.
• Alcohol: Consuming too much alcohol can strain the liver, which is closely connected to the spleen. This can lead to enlargement of both organs and should be avoided if you have an enlarged spleen.
• Refined carbohydrates: White bread, white rice, and sugary snacks are examples of refined carbohydrates that lack the nutrients the body needs to operate properly. Eating too much of these types of foods can lead to nutritional deficiencies which may contribute to an enlarged spleen.

• Splenectomy: The spleen is surgically removed during a splenectomy. It is usually recommended when other treatments fail to reduce the size of the spleen or if the spleen is causing serious health complications.
• Laparoscopic Surgery: A tiny camera and surgical tools are placed via minute incisions in the abdomen during laparoscopic surgery to access and remove all or part of the spleen.
• Radiofrequency Ablation: This method employs heat produced by radio waves to shrink and destroy swollen splenic tissue.
• Cryoablation: This procedure uses extreme cold temperatures to destroy enlarged splenic tissue and reduce its size.

A patient with enlarged spleen (splenomegaly) should consult a gastroenterologist, who specialises in the diagnosis and treatment of diseases of the gastrointestinal tract, including the liver and pancreas.

In addition to this, a haematologist or an oncologist may need to be consulted depending on the underlying cause of the enlarged spleen.

• Corticosteroids: This class of drugs is used to reduce inflammation and suppress the immune system, which can help to treat an enlarged spleen caused by an underlying autoimmune disorder. Examples include prednisone and methylprednisolone.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications are used to treat pain and inflammation brought on by splenic enlargement.Examples include ibuprofen, naproxen, and aspirin.
• Antibiotics: These drugs may be prescribed to treat any infection that is causing the spleen to swell. Examples include amoxicillin, ciprofloxacin, and levofloxacin.
• Statins: Statins are cholesterol-lowering drugs that can help reduce inflammation in the body and prevent certain infections that may be causing an enlarged spleen. Examples include atorvastatin and simvastatin.
• Immunosuppressants: Immunosuppressants are used to reduce the activity of the immune system in order to stop it from attacking healthy tissue or organs, which can cause an enlarged spleen in some cases. Examples include azathioprine, mycophenolate mofetil, and cyclophosphamide.

Recovery from Enlarged Spleen (Splenomegaly) depends on the underlying cause, severity of the condition, and the treatment received.

According to each situation, the recuperation period may generally last anywhere from a few weeks and many months.

No, the results of treatment for enlarged spleen are not permanent. While treatment can reduce the size of the spleen, it is possible for the spleen to become enlarged again in the future.

As a result, it's crucial to keep an eye out for any changes in the spleen.

Post-treatment guidelines include advice regarding:

• Rest: Patients should aim to get plenty of rest in order to recover more quickly.
• Diet: Eating healthy foods and avoiding unhealthy foods can help promote healing and prevent complications.
• Exercise: Low-impact exercises can be beneficial for recovery, but strenuous activities should be avoided until the treatment has had time to take effect.
• Follow-up care: After receiving treatment, it is crucial for patients to follow up with their doctor to make sure that any side effects or problems are quickly dealt with.

Depending on the underlying cause of the problem, different treatment options for enlarged spleens (splenomegaly) are priced differently in India.

Generally, the cost may include hospitalisation, surgery, medications, diagnostic tests, and follow-up care.

A few thousand to many lakhs of rupees might be spent overall.

Common side-effects from splenomegaly treatments may include:

• Fatigue: The spleen plays an important role in filtering out old red blood cells, so any treatments that affect its function can lead to anaemia and fatigue.
• Low Blood Cell Counts: Treatments for splenomegaly often involve removing some of the spleen tissue or surgically removing the spleen entirely (splenectomy). This can reduce the production of red blood cells and other important components of the blood, leading to a low blood cell count (anaemia).
• Abdominal Pain: Surgery to remove part or all of the spleen can cause abdominal pain as well as nausea and vomiting.
• Infections: Removal of the spleen increases a person’s susceptibility to infection because it plays a key role in filtering out bacteria and other pathogens from the bloodstream. For this reason, people who have had their spleens removed are usually advised to take antibiotics prophylactically (as a precaution) if they are exposed to certain infections.

In order to avoid consequences like 'pain, infection, haemorrhage, exhaustion, etc.,' which may last anywhere from a few months to years depending on how severe the condition is, you should visit a doctor in your area if you have an enlarged spleen.