The spleen is found in the left upper quadrant of the abdomen and should not normally be felt during a physical exam. Even an enlarged spleen can be difficult to palpate especially in obese patients, because unlike the liver on the right side of the abdomen, its lower edge can be soft and hard to appreciate.
When enlarged, many patients complain of a feeling of fullness and early satiety when eating. It is at increased risk of injury in an accident. It also can do too thorough of a job of culling older more fragile blood cells leading to anemia and low platelets.
Although we can live without our spleen, it performs a few helpful functions. If the spleen is removed due to injury or other problems, its functions can be taken over by other organs such as the liver, the bone marrow and the lymph nodes. If possible, it is best to be vaccinated four to six weeks before splenectomy to protect against the encapsulated bacteria. That included the shots against pneumonia, meningococcus and HIB haemophilus influenza B and also the flu jab if appropriate.
Splenectomy can often be done in a laparoscopic procedure that has a shorter recovery time. As it is not a common surgery such as a laparoscopic gallbladder removal, research supports searching out an experienced surgeon to lower the risk of complications. Splenules or accessory spleens are rare, small congenital collections of normal splenic tissues that can grow larger and start normal functioning when the spleen is removed. In CLL, the spleen may not be a clinically involved in any significant way and may be of no concern, or it can become massively enlarged, a condition called splenomegaly.
That can lead to a full feeling in the abdomen and early satiety sense of not being hungry. Splenomegaly that causes complications is one indication for treating CLL. An enlarged spleen can lead to a significant drop in the red blood cell and platelet counts.
Any therapy that successfully treats CLL will also treat the CLL in the spleen and will lead to a shrinking of the spleen think of it as a huge CLL node back to normal size with relief of symptoms and improved blood counts. While the spleen has long been associated in literature with the emotions, especially melancholy, it is in truth both a multitasking and fully expendable organ that can cause problems for those of us with CLL. Serum protein electrophoresis identifying a monoclonal gammopathy or decreased immunoglobulins suggests lymphoproliferative disorders or amyloidosis Amyloidosis Amyloidosis is any of a group of disparate conditions characterized by extracellular deposition of insoluble fibrils composed of misaggregated proteins.
These proteins may accumulate locally Symptoms begin as an acute febrile illness with few or no localized signs and may progress to a chronic stage with TB most commonly affects the lungs. Symptoms include productive The lungs and lymphatic system are most often affected, but Flow cytometry can identify a small monoclonal lymphocyte population suggestive of lymphoma. Elevation of serum uric acid suggests a myeloproliferative or lymphoproliferative disorder. Elevation of leukocyte alkaline phosphatase LAP suggests a myeloproliferative neoplasm, whereas decreased levels suggest chronic myelocytic leukemia.
If testing reveals no abnormalities other than splenomegaly, the patient should be reevaluated at intervals of 6 to 12 months or when new symptoms develop. Treatment is directed at the underlying disorder. An enlarged spleen itself in an asymptomatic patient needs no treatment unless severe hypersplenism Hypersplenism Hypersplenism is cytopenia caused by splenomegaly. Patients with palpable or very large spleens probably should avoid contact sports and weight-lifting to decrease the risk of splenic rupture.
When testing for etiology of splenomegaly and no cause is immediately apparent, infectious causes are important to exclude. Asymptomatic patients with an enlarged spleen do not require treatment but should avoid contact sports and weight-lifting to decrease the risk of splenic rupture. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. The Manual was first published in as a service to the community.
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Courtesy of. History Physical examination Testing. Key Points. Spleen Disorders. Test your knowledge. Nausea and vomiting are common adverse effects of either the cancer itself or of the treatment for cancer. Several drugs are available to administer prior to chemotherapy for anticipatory nausea and vomiting.
Of these drugs, which of the following is the most effective yet the most expensive? More Content. Splenomegaly By Harry S. Skip to Content. This is called the stage. Use the menu to see other pages. Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body.
Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis.
There are different stage descriptions for different types of cancer. There is a relationship between the stage of the CLL and the prognosis. In general, patients diagnosed at an earlier stage have better long-term survival. Importantly, however, there is a wide range of outcomes even for patients who have the same stage, and the stage alone cannot predict the prognosis with certainty for each person.
If the CLL grows and worsens, the stage may change over time. Below are explanations of commonly used staging and classification systems used by doctors to describe CLL.
This staging system classifies the leukemia according to whether a patient has, or does not have, any of the following:. Stage 0: The patient has lymphocytosis with more than lymphocytes per microliter of blood, but no other physical signs.
Stage I: The patient has lymphocytosis and enlarged lymph nodes.
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