Splenomegaly is defined as enlargement of the spleen, measured by size or weight.
Symptoms of Splenomegaly
The symptoms due to enlargement of the spleen are abdominal discomfort and pain. Massive enlargement of the spleen may cause early satiety and abdominal bloating due to abdominal compression. Splenic infarction may result in severe pain radiating to the left shoulder. Repeated splenic infarction is sickle cell disease may lead to splenic destruction (autosplenectomy). Rupture of spleen can occur spontaneously or due to trauma and this may be fatal. Pancytopenia may occur in patients with enlargement of the spleen (hypersplenism).
Causes of enlargement of the spleen
Hyperplasia in response to infection
- Malaria and kala azar
- Infectious mononucleosis, cytomegalovirus infection, HIV infection, and viral hepatitis.
- Endocarditis, tuberculosis, typhoid fever, and septicemia
Hyperplasia due to excessive function of red cell removal
- Spherocytosis, thalassemia, and early sickle cell disease.
Hyperplasia in response to immune disorder
- Felty’s syndrome, SLE, and Sarcoidosis
- Myelofibrosis and marrow infiltration
- Portal hypertension (cirrhosis, hepatic vein obstruction, portal vein thrombosis).
Infiltration of spleen
- Leukemia’s, lymphomas, myeloproliferative disorders, amyloidosis, and storage disease (Gaucher’s disease, Niemann-Pick disease).
Causes of massive enlargement of the spleen
- Chronic myeloid leukemia
- Portal hypertension
- Kala azar
(Tripathi; Essential of Medicine for Dental Students ; 2008 ; 66-67)
Homeopathic treatment of enlargement of the spleen
Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat enlargement of the spleen but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available to treat enlargement of the spleen that can be selected on the basis of cause, sensations and modalities of the complaints. For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are following remedies which are helpful in the treatment of enlargement of the spleen:
Aurum Mur, Capsicum, Phosphorous, Cina Officinalis, Iodum, Natrum Mur, Arsenic Album, Chininum Sulph, Sulphuric Acid, magnesia Mur, Phosphoric Acid, Cocculus and many other medicines.
The only sphere of action of this remedy seems to be in splenic troubles, and Burnett believes it to be a true organ remedy for the spleen. Its indications are deepseated pain in the splenic region, deep stitches, worse in damp weather, with enlargement of the spleen. Chronic pains in the spleen. Pain in whole left side, with shortness of breath. A splenic stitch usually requires one of the following remedies: Chelidonium, Berberis, Sulphur,Conium or Ceanothus. Scilla has pain in the left hypochondria region, and also in the epigastric region, relieved by lying on the right side. Cimicifuga. Bayes recommends this remedy in neuralgic pains in the splenic region with uterine complaints. Ranunculus bulbosus. Boenninghausen and Dunham considered this remedy of value in splenic troubles; soreness, stitches and pulsations in splenic region are present.
This remedy corresponds to congestion, pain and stitches in the region of the spleen with swelling of the spleen, splenitis. Dull aching in region of spleen. Hyperaemia of spleen. Nervous system is sensitive, physical or mental effort aggravates. Chininum sulphuricum. Congestion, inflammation and enlargement of the spleen. Aranea diadema. Enlarged spleen. Especially useful for the chronic effects of malarial poisoning or in those who live in damp, wet places. Languor, lassitude, constant chilliness are useful symptoms. Grindelia robusta has pain in the splenic region; it has also enlargement and tenderness in this region. It seems to be applicable to any pain in the left side extending as low as the hip and as high as the nipple. It may be a sore aching or a keen cutting pain.
One of our most efficient remedies for sensitive swollen and enlarged spleens, according to Jahr. Arnica. Splenitis from injury, patient dull and apathetic. There is much testimony in favor of Arnica, especially where there is a typhoid tendency and dull or even acute pains. Bellis, which causes swelling in splenic region, Natrum muriaticum and Ferrum metallicum should also be thought of in enlarged spleen. Natrum muriaticum produces stitches, pressure and congestion in the spleen. Swollen spleens resulting from malarial fever. Patient anaemic, upper part of body emaciated, inclined to take cold; much quinine taken is an additional indication. Patient craves salt.
Enlarged spleen associated with alcoholic cirrhosis of liver, ankles swollen.
Swollen spleen accompanied by constipation and craving for salt, especially if person is oversensitive and gets even more upset when consolation is offered.
The spleen is an important organ of the body. Its main function is to filter the blood and to make antibodies. An enlarged spleen, which can be felt through the walls of the abdomen, is often an indication of disease somewhere in the body. The spleen is also an integral part of the lymphatic systemâ€”the basis of body’s defense against infection.
The spleen lies just below the diaphragm at the top of the left hand side of the abdomen. It is normally about 5 inches (13cm) long, and it lies along the line of the tenth rib. The spleen usually weighs about ½ pound (about 200g) in cases of enlargement of the spleen; it can weigh up to 4½ pounds (2kg) or more.
If a spleen is examined with the naked eye, it will look like a fibrous capsule surrounding a mass of featureless red pulp. It may just be possible to make out little granulations called Malpighi an corpuscles. The organ is supplied with blood via the splenic artery, which, like any other artery.
Positions of the spleen
The spleen is situated in the top left hand corner of the abdomen, just below the diaphragm. It is in a relatively exposed position, and so it is frequently damaged in accidents and has to be removed, generally without any ill effects.
Splits first into smaller arteries and then into tiny arterioles, However, the arterioles of the spleen are unusual in that they are wrapped in lymphatic tissue as they pass through the pulp of the spleen. The arterioles are unique in another way; instead of being connected to a network of capillaries. They appear to empty out into the main pass of the spleen.
The unusual way in which the spleen is supplied with blood what enables it to perform two of its basic functions. First, the fact that the arterioles are wrapper with lymphatic tissue means that the lymphatic system comes into immediate contact with any abnormal protein in the blood and forms antibodies to it. Second, the way that the blood empties directly into the pulp of the spleen also allows the reticular cells of the organ to come into the direct contact with the blood, filtering it of any old or worn-out cells
Functions of spleen
The spleen is one of the main filters of the blood. Not only do the reticular cells remove old and worn out blood cells, but they will also remove any abnormal cells. This applies, in particular, to red blood cells, but white cells and platelets are also selectively when necessary by the spleen.
The spleen will also remove abnormal particles floating in the bloodstream. This mans that it plays a major part in ridding the body of harmful bacteria. It is also instrumental in making antibodies proteins circulating in the blood that will bind onto and immobilize a foreign protein so that white blood cells called phagocytes can destroy it. The Malpighian corpuscles, which are collections of lymphocytes, produce that antibody.
In some circumstances, the spleen has an important role in the manufacture of new blood cells. This does not happen in the normal adult, but in people who have a bone marrow disease the spleen and the liver are major sites of red blood cell production. In additions, the spleen makes a large proportion of the blood of an unborn baby.
Feeling the spleen
The spleen cannot be felt in normal healthy people, but there is a large range of disease that cause enlargement of the spleen, which can then be felt through the walls of the abdomen. The procedure is that the patient lies on his or her back, and the doctor starts to feel (or palpate) the bottom of the abdomen, and then works up toward the top left hand corner. The spleen moves as the patient breathes, so that this movement can be felt. Enlargement of the spleen can also be detected on x rays or by using a radioactive isotope scan.
(David B. Jacoby, R. M. Youngson: Encyclopedia of Family Health; 2044-45)