Enlarged Spleen (Splenomegaly) (cont.)

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What are the symptoms of an enlarged spleen?

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An enlarged spleen itself usually causes no symptoms; the symptoms of an underlying disease are often the reason a patient might seek care. These may include weakness and fatigue from anemia, easy bleeding because of decreased platelets in the bloodstream, or recurrent infections from poor white blood cell function.

However, as the spleen enlarges, it can press up against the diaphragm, the muscle that separates the chest and abdominal spaces. Diaphragm irritation may refer pain to the left shoulder. An enlarged spleen can also push toward the stomach and cause anorexia or a loss of appetite and a sense of early fullness when eating.

Since the enlarged spleen grows beyond the protection of the ribcage it becomes more likely to be injured, thereby increasing the chance that abdominal pain may occur.

Depending upon the amount of spleen damage after injury, there can be bleeding into the abdomen with associated distention (bloating), pain to the back and shoulder, and signs and symptoms of shock. These can include weakness, shortness of breath, and cool, clammy and sweaty skin.

When should I seek medical care for an enlarged spleen?

Most often, the diagnosis of an enlarged spleen is made incidentally by the care provider. There are usually no symptoms that would bring a patient to see a doctor. However, unexplained symptoms like those mentioned above should be investigated by a care provider.

How is an enlarged spleen diagnosed?

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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, to confirm or rule out the diagnosis of infectious mononucleosis. 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.

Medically Reviewed by a Doctor on 12/2/2013

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