The Spleen

The spleen is shaped like a fist or an oval and is located in the upper left area of the abdomen near the stomach, diaphragm and kidney. It is around 5 inches long and 3 inches wide and weighs less than half a pound. The spleen is composed of red pulp and white pulp which holds macrophages and lymphocytes. It is considered a part of the lymphatic system and is in fact the largest lymph structure in the body.

The Lymphatic System

Understanding the spleen requires some understanding of the lymphatic system. This system is composed of lymph vessels and lymph nodes. These vessels transport a kind of fluid called lymph which washes the different internal parts of the body. The lymph is then brought to the lymph nodes where bacteria and other harmful cells are destroyed. The spleen helps in this vital function of the lymphatic system and more.

Function of the Spleen

The white pulp holds the lymphocytes and macrophages that help fight infection. The macrophages in particular surround bacteria and harmful foreign particles and destroy and dispose of them. The red pulp gets its color from the blood that fills it. It is responsible for getting rid of dead or old cells of the blood. In this sense, it manages the body’s blood supply. In some animals, the spleen is an emergency storage area for blood. It does not have this function in humans but it does store platelets in a similar way also for emergency use.

Although the spleen was poorly understood in the past, it is now believed that the lack of it may make a person more prone to certain infections like septicemia. In rare instances, some people may be born without a spleen but it is more common for the spleen to have to be removed for medical reasons.

Splenomegaly

It is normal for the spleen to enlarge a bit due to digestive processes. In some people however the spleen may become enlarged due to other reasons. It is possible that blood flow could become blocked or the spleen could become infected with a virus or bacteria. Certain conditions may naturally lead to an enlargement of the spleen. Some of these conditions include:

• Malaria

• Leukemia

• Rheumatoid arthritis

• Mononucleosis

• Systemic lupus

• Gaucher’s disease

• Cysts

• Sickle cell anemia

• Some kinds of anemia

Lymphoma

Lymphoma is the general term for the kind of cancer that affects the lymphatic system. Since the spleen is a part of this system, cancer cells can find their way to the spleen too. There are 35 subtypes of lymphoma with two main types—Hodgkin’s and non-Hodgkin’s.

Lymphoma may begin with lymphocytes multiplying uncontrollably in the lymph nodes. The cancer cells may eventually travel through the lymphatic system beginning with invading regional nodes until it reaches the spleen and other organs.

Why Remove the Spleen

The spleen may not always have to be removed even when there is some damage to it. A surgeon who may also work with other experts to determine a patient’s condition is the best judge on whether a spleen can still be repaired or surgery is really needed. Given below are some possible reasons that may require the removal of the spleen”

• The spleen has to be removed if injury to the chest or abdomen results in severe spleen rupture. Non removal of the spleen in this case may lead to too much blood leaking into the abdomen which may cause death.

• If a primary cancer affects the spleen, it may be removed to prevent the spread of cancer cells. Sometimes the spleen may also be taken out if a patient has lymphoma. This will allow your doctor to determine the extent or stage of your cancer. This kind of splenectomy has a similar idea or concept to sentinel lymph node removal.

• Certain autoimmune disorders affecting the blood may require splenectomy. One example is idiopathic thrombocytopenic purpura in which platelets are mistakenly eliminated in the spleen. Some autoimmune hemolytic conditions also result in the immune systems mistakenly attacking red blood cells and may require splenectomy.

• Myelofibrosis is a condition that primarily affects the bone marrow. It may lead the painful enlargement of the spleen which may have to be removed.

• Other rare conditions and infections that bring about the severe and painful enlargement of the spleen that cannot be treated through any other non invasive procedures may require splenectomy

Removing the Spleen

There is more than one way to remove the spleen. The procedure used will depend on the patient’s condition and the doctor’s judgment.

• The spleen may be removed through open surgery if the organ has become too large or if it has ruptured considerably. In this procedure, the artery of the spleen is tied to prevent too much bleeding before the organ is detached. This is performed under general anesthesia.

• Under certain conditions, laparoscopic splenectomy is a good alternative to open surgery. It is less invasive, leaves fewer scars and allows faster patient recovery. The procedure is performed by making three small incisions on the abdomen. A tube with a light and camera is inserted through one incision. This will give your surgeon a clear view of your spleen and other organs. The surgical tools used to remove the spleen are inserted through the other incisions. Before the tools are inserted, carbon dioxide is pumped to raise the abdomen and provide more space for the surgeon. This is also performed under general anesthesia.

Causes

The most common cause of a ruptured spleen is if a person gets violently hit on the areas nearest the spleen. The spleen could get damaged if the rib cage, abdomen or left chest is hit by hard force. It is easy to imagine that injury to these areas would normally happen during rough contact sports, car accidents or other kinds of physically damaging activities and accidents. In some instances, the spleen may not immediately rupture. It may become enlarged first for some time before eventually rupturing.

People with infections that enlarge their spleens are particularly at great risk of ending up with ruptured spleens if they engage in contact activities and sports.

Symptoms

Sometimes, if the rupture is small, bleeding may proceed gradually and there may be no immediately apparent symptoms. This is a dangerous situation though because the first symptoms a person may feel are the signs that accompany low blood pressure and lack of oxygen to the brain. One may become dizzy, faint, confused and light headed.

In people who have large ruptures, the symptoms may be more obvious and immediate. The first obvious symptoms would be pain in the abdomen area and some tenderness. This is caused by blood leaking into the abdomen. In some cases, the pain may radiate to the left shoulder.

You should immediately tell your doctor if you have any symptoms of a ruptured spleen. Your condition could quickly become life threatening if you do not receive treatment. Although the spleen is not considered as absolutely necessary to human survival, it could kill you if too much blood from it enters the abdomen.

Treatment

Treatment for a ruptured spleen will depend on the severity of a patient’s condition. If the doctor suspects that it is not an emergency situation, he may ask a patient to undergo blood and imaging tests first to clearly determine if the spleen has indeed ruptured. If the rupture is not big, a surgeon may be able to fix it without removing the entire organ.

In emergency cases, like severe accidents, where it is clear that a patient has considerable damage to the spleen, the doctor may have to remove the whole organ. This may require open surgery.

An alternative to open surgery for less urgent cases would be the removal of the spleen using a laparoscope. A thin tube with a camera is inserted through a small incision. Other tools are then inserted through other small incisions to remove the spleen.

Just like lymph nodes, the spleen may become enlarged due to bacterial, parasitic or viral infections. The organ however, can also increase in size due to certain conditions that may affect the blood. Various kinds of hemolytic anemia and leukemia may therefore cause swelling. Diseases of the liver such as biliary atresia, cirrhosis and Wilson’s disease may also cause enlargement.

One other possible dangerous cause of enlargement is lymphoma. This is cancer which affects the lymphatic system. Cancer cells that originate from the lymph nodes may easily spread to the spleen.

An enlarged spleen that is not promptly treated may be damaged. The least that can happen is that its functions may become impaired. A patient may have a bigger problem though if the spleen actually ruptures. This can cause considerable internal bleeding.

Symptoms

It is possible for the spleen to become enlarged without showing any symptoms. If there are any symptoms, they may be so vague that a person may easily confuse the condition with something else. An affected person may have constant hiccups and may not be able to eat as much as his usual appetite would permit. Some patients may also feel a little tired.

A crucial symptom that not all patients experience is abdominal pain the in the area where the spleen is. The pain may be so severe for some that it may radiate from the abdomen area to the left shoulder and back. See a doctor immediately if you experience any pain.

Going to the Doctor

Pain is often the first symptom that can send people running to the doctor. During a check up for an enlarged spleen, the doctor conducts an interview first to determine all apparent symptoms and find out if there are other medical conditions that may cause the symptoms.