Enlarged spleen

splenomegaly

As enlarged spleen or spleen swelling (medicated splenomegaly) is an acute or chronic enlargement of the spleen referred, which among other things can lead to abdominal pain, nausea and vomiting and feeling of fullness. Splenomegaly is not a disease of its own, but a finding which, in common with the different functions of the spleen, may have very different causes - but in most cases there are infectious diseases (eg, glandular fever, fever, blood disorders, eg, leukemia or Hodgkin's disease). In addition, splenomegaly can also be caused by rheumatic diseases or sepsis.

contents

• splenomegaly
• Synonyms
• The spleen
• Definition Enlarged spleen
• symptoms
• Causes of enlarged spleen
• diagnosis
• Therapies and treatment options
• Applications in naturopathy

Synonyms

Spleen enlargement, enlargement of the spleen, splenomegaly, splenomie, enlarged spleen.

The spleen

The spleen (Latin: Lien, Greek: Splen) is about 11 × 7 × 4 cm large and 150-200 grams heavy organ, which belongs to the so-called "lymphatic system" and in the upper left abdomen, more precisely below the diaphragm and above the diaphragm left kidney is located. The bean-shaped organ is surrounded by a tight connective tissue capsule, which protects the actual spleen tissue - the spleen pulp - and has three essential tasks: First, certain white blood cells (the so-called B and T lymphocytes) mature in it to ward off foreign substances. On the other hand, it is used for the filtration and degradation of obsolete red blood cells and as a storage place for white blood cells and platelets (monocytes). The different functions of the spleen also become clear in color: the area responsible for the immune defense, for example, appears white (white pulp), while the spleen's blood filter is of a deep red color (red pulp).

In addition to the actual spleen, about 10 percent of humans also have one or more so-called "accessory spleens" (splen accessorius), i. small nodular organs of spleen tissue, which are identical in structure and function with the "main spleen" and are usually near the spleen. If a spleen has to be surgically removed due to a disease, these secondary spleens also become relevant - because without complete removal of all spleens, the disease can not completely heal.

Spleen is a vital organ before birth and toddler, as it plays a key role in the formation of white blood cells and (slightly less) red blood cells. For adults, however, it is not vital, as its functions can be taken over by the liver, bone marrow, and other lymphoid organs. Accordingly, removal of the spleen (for example, as a result of heavy bleeding) usually does not entail serious complications, but it is frequently found in individuals with an inoperative or missing spleen that they are more susceptible to infections.

Definition Enlarged spleen

An enlarged spleen (splenomegaly) refers to an acute or chronic enlargement of the spleen, i. Normally, an increase of the organ weight by 350g or exceeding the normal values ​​(length 11cm, width 7cm, thickness 4cm). For a more precise determination of the extent of splenomegaly, a distinction is made in three stages: For instance, the organ weight is less than 500 g for mild splenomegaly, 500 to 800 g for a moderate splenomegaly and more than 1,000 g for a massively enlarged spleen.

The volume of the spleen can increase significantly as a result of different diseases. (Image: joshya / fotolia.com)

symptoms

In many cases, a swollen or enlarged spleen hardly causes symptoms. However, if the spleen is so large that it presses on the stomach or other organs in the abdomen, it often causes a feeling of fullness, general malaise or nausea and vomiting, sometimes pressure complaints occur during the meal, in other cases, even without eating becomes. In addition, spleen pain due to an enlarged organ may occur in some cases in the form of abdominal pain and / or back pain in the spleen region, in some patients the pain also extends to the left shoulder, chest or back.

For the most part, however, symptoms of the disease that are the basis of spleen enlargement are predominant: fever (for example, in infections), painful swollen lymph nodes on the neck (in Pfeiffer's glandular fever), or joint problems (in rheumatic diseases) often occur here.

In addition, an enlarged spleen can lead to hyperfunction (hyperspleniasyndrome), i. H. cause excessive levels of blood cell degeneration, often accompanied by typical symptoms of anemia such as paleness, tiredness, weakness or palpitations. In this context, if there is a deficiency of white blood cells, this often means a higher susceptibility to infectious diseases, in the case of diminished platelets, it may also be in those affected, for example. come to nosebleeds faster.

Causes of enlarged spleen

In most cases, splenomegaly is the result of other diseases or infections, and rarely is there a disease that only affects the spleen itself. Often there are diseases of the blood or the lymphatic system, such. As leukemia or Hodgkin's disease, a malignant tumor of the lymphatic system.

In addition, an enlarged spleen is often also caused by infectious diseases such as Tuberculosis, malaria or the Pfeiffer glandular fever, a common and usually harmless disease caused by Epstein-Barr virus. Sepsis can also be considered a cause in which an infection spreads unchecked in the body, can therefore quickly become life-threatening and must therefore be treated quickly.

Also, rheumatic diseases such as systemic lupus erythematosus or so-called "storage disorders" can cause splenomegaly, i. Disturbances of metabolism, which lead to an accumulation of metabolic products in tissue and organs, which are subsequently altered pathologically (such as Gaucher's disease).

In addition, hepatic congestion may be the trigger if the blood backs from the gastrointestinal tract to the spleen instead of draining through the liver via the portal vein. Such a congestion can be caused by a number of diseases, e.g. due to liver cirrhosis or inflammation of the pancreas (pancreatitis) and the liver (hepatitis). Also tumors or cysts, i. Fluid-filled spleen tissue cavities can cause splenomegaly.

In addition, anemia (anemia) in the form of a ball cell anemia may be associated with enlarged spleen. Characteristic of this most common hemolytic anemia in Central Europe is a pathologically increased reduction of red blood cells by the spleen. As a trigger of splenomegaly, affecting the spleen as such, bruising (haematomas) or blood sponges (hemangiomas) of the organ may eventually be considered.

With the help of an ultrasound examination changes of the spleen can be detected. (Image: Christoph Droste / pixelio.de)

diagnosis

In a first step, the physician is usually used to determine a splenomegaly, a physical examination, because unlike the healthy spleen, an enlarged spleen can be palpated left below the costal arch, when the patient takes a deep breath.

An ultrasound examination (ultrasonography) and other imaging techniques such as computed tomography can then provide information about the size of the spleen and the cause of the enlargement. Blood tests are also carried out in most cases - here the size and shape of the blood corpuscles provide information about the cause of splenomegaly; a bone marrow examination can also reveal blood cancers such as leukemia or a lymphoma or an accumulation of undesired substances (storage disease). With the help of a measurement of the protein content in the blood also diseases like malaria and tuberculosis can be excluded.

Another option for reliably identifying spleen splenomegaly or spleen hyperfunction (hyperspleniasyndrome) is the so-called "scintigraphy" - an imaging method of nuclear medicine diagnostics in which the blood cells can be stained with a special substance and thereby made visible.

Therapies and treatment options

The treatment of splenomegaly usually depends on the underlying disease. If this can be successfully cured or brought under control, this usually has a positive effect on the enlarged spleen. However, if there is no success or further complications (such as anemia or platelet deficiency), surgical removal of the spleen (splenectomy) is rarely performed. However, such an intervention may be e.g. also be necessary in the event of a splenic tear as a consequence of a serious accident. The operative procedure is very diverse - so there is always the possibility to remove the spleen completely (total splenectomy) or only partially (subtotal splenectomy). These interventions may be minimally invasive today, but open surgery may be appropriate depending on the underlying disease or the size of the spleen.

Since the spleen plays an important role in the immune system in the human body, after the removal of the organ normally there is an increased risk of infection against infections with bacteria (eg pneumococci, meningococci and Haemophilus influenzae), whereby in particular forms of pneumonia, meningitis and Ear or sinus infections play a central role. As an important, very effective precautionary measure, vaccination against the most commonly encapsulated bacteria has been shown in patients after taking a spleen. For planned procedures, the patient should be vaccinated 2-3 weeks prior to the operation, and the vaccine must be repeated every 5-10 years, because infections with the mentioned bacteria can be severe after a splenectomy. Especially in children and adolescents whose immune system is significantly weaker than in adults, often show a particularly high susceptibility to these infections and usually more serious disease patterns - therefore, an operative removal of the spleen is possible after the age of 6 carried out.

An alternative method of relieving discomfort caused by a swollen spleen is, in some cases, radiotherapy of the entire organ with extremely low radiation doses (0.2 Gy)..

Applications in naturopathy

Naturopathy is often shown to be a sensible and effective supplement or alternative to conventional therapy, especially with regard to the diverse functions of the spleen. In general, in connection with spleen disorders, it is often recommended from a naturopathic point of view, in addition to the direct treatment of the spleen, to pay particular attention to a regulated acid-base balance and a corresponding diet, i. a balanced and natural food with many vital and mineral substances and vitamins.

While a special spleen diet hardly plays a role in local medicine, it is firmly anchored in traditional Chinese medicine (TCM) and is used to strengthen spleen qi, which has the task of extracting the energy from the diet and eating it to provide the body completely. In this context, a slightly sweet and bitter diet is recommended in TCM, the bitter substances should come from vegetables (eg fennel), fruits and herbs (eg coriander, cloves) and the sweetness is achieved by extensive chewing, as in this way the Carbohydrates already be converted to sugar. Hot foods are also beneficial for the spleen, so the Chinese recommend a cooked diet with wholemeal porridge
Wheat, oats, barley, rice, millet, corn and chestnuts. In addition, in many cases u.a. Legumes and nuts, lean meat of chicken, pheasant or sheep, some fish species and various spices (e.g., cloves, star anise, nutmeg and cinnamon) are considered suitable.

In the Western herbal or herbal medicine (phytotherapy) are generally only sporadic medicinal plants, which are attributed to a strong reference to the spleen - in the case of splenomegulum Grindelia and Scolopendrium (Hirschzungenfarn) come into question, beyond that are also the bitter plants, such as eg Calamus, gentian, ginger, dandelion or vermouth. The medicinal plants can generally be taken either as Teedrogen or in the form of medicinal preparations as well as homeopathic remedies, in the field of homeopathy also found in spleen enlargement often Ceanothus americanus application.

Regardless of the specific nature of the naturopathic treatment, a specialized specialist should first be consulted to rule out any serious illness or injury that might require surgery. In addition, any form of alternative medicine should be consulted and coordinated with a dedicated expert to develop the best possible therapy and eliminate risks. (No)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)