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Enlarged spleen (splenomegaly)

Your spleen is an organ located just below your rib cage on your left side. A number of conditions — from infections to liver disease and some cancers — can cause an enlarged spleen, also known as splenomegaly (spleh-no-MEG-uh-lee).

Most people don't have symptoms with an enlarged spleen. The problem is often discovered during a routine physical exam. Your doctor can't feel a normal-sized spleen in adults — unless you're very slender — but can feel an enlarged spleen. If you have an enlarged spleen, your doctor will likely request imaging and blood tests to help identify the cause.

Treatment for an enlarged spleen focuses on relieving the underlying condition. Surgically removing an enlarged spleen isn't usually the first treatment, but it may be recommended in certain situations.

Symptoms Causes Risk factors Complications

An enlarged spleen may cause:

  • No symptoms in some cases
  • Pain or fullness in the left upper abdomen that may spread to the left shoulder
  • Feeling full without eating or after eating only a small amount — this can occur when an enlarged spleen presses on your stomach
  • Anemia
  • Fatigue
  • Frequent infections
  • Easy bleeding

When to see a doctor

See your doctor promptly if you have pain in your left upper abdomen, especially if it's severe or the pain gets worse when you take a deep breath.

A number of infections and diseases can contribute to an enlarged spleen. The effects on your spleen may be only temporary, depending on how well your treatment works. Contributing factors include:

  • Viral infections, such as mononucleosis
  • Bacterial infections, such as syphilis or an infection of your heart's inner lining (endocarditis)
  • Parasitic infections, such as malaria
  • Cirrhosis and other diseases affecting the liver
  • Various types of hemolytic anemia — a condition characterized by premature destruction of red blood cells
  • Blood cancers, such as leukemia, and lymphomas, such as Hodgkin's disease
  • Metabolic disorders, such as Gaucher's disease and Niemann-Pick disease
  • Pressure on the veins in the spleen or liver or a blood clot in these veins

How the spleen works

Your spleen is tucked under your rib cage next to your stomach on the left side of your abdomen. It's a soft, spongy organ that performs several critical jobs and can be easily damaged. Among other things, your spleen:

  • Filters out and destroys old and damaged blood cells
  • Plays a key role in preventing infection by producing white blood cells called lymphocytes and acting as a first line of defense against invading pathogens
  • Stores red blood cells and platelets, the cells that help your blood clot

An enlarged spleen affects each of these vital functions. For instance, as your spleen grows larger, it begins to filter normal red blood cells as well as abnormal ones, reducing the number of healthy cells in your bloodstream. It also traps too many platelets. Eventually, excess red blood cells and platelets can clog your spleen, interfering with its normal functioning. An enlarged spleen may even outgrow its own blood supply, which can damage or destroy sections of the organ.

Anyone can develop an enlarged spleen at any age, but certain groups are at higher risk, including:

  • Children and young adults with infections, such as mononucleosis
  • People who have Gaucher's disease, Niemann-Pick disease, and several other inherited metabolic disorders affecting the liver and spleen
  • People who live in or travel to areas where malaria is endemic

Potential complications of an enlarged spleen are:

  • Infection. Because an enlarged spleen can reduce the number of healthy red blood cells, platelets and white cells in your bloodstream, you may develop frequent infections. Anemia and increased bleeding also are possible.
  • Ruptured spleen. Even healthy spleens are soft and easily damaged, especially in car crashes. When your spleen is enlarged, the possibility of rupture is far greater. A ruptured spleen can cause life-threatening bleeding into your abdominal cavity.
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