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6708370 tn?1471490210

How does a liver doc screen for Enlarged Spleen?

Can this be done by an experienced doctor simply by palpitating the spleen? I was told a few years ago that my spleen was enlarged but when I have an ultrasound, they only check the liver

I asked if they could do some imagery on the spleen as well but got the I Can Only Do What Your Doctor Ordered response - even though they are so close together

Or perhaps they can tell because of low platelets? Or by a Catscan?
5 Responses
446474 tn?1446347682
COMMUNITY LEADER
Splenomegaly (an enlarged spleen) like most medical conditions can be detected in numerous ways.

The simplest way is with a simple physical exam. As part of an abdominal exam palpation and percussion can be used to note physical abnormalities in both the spleen and the liver. My primary doctor first diagnosed my cirrhosis with an abdominal exam. Since that time I have had dozens of doctor perform the exam and even medical students have measured the size of my liver and spleen and detect ascites with this simple 1 minute exam.

Splenomegaly is a common complication of cirrhosis and portal hypertension. Cirrhosis (scar tissue in the liver) can interfere with that blood flow. The blood isn't able to pass easily through the liver. Pressure builds up in the portal vein. (“Portal Hypertension”) The spleen enlarges. (Because the spleen is still receiving all that blood from the splenic artery..... but the blood is having a hard time leaving the spleen, and traveling through the liver)
Splenomegaly causes thrombocytopenia (low platelet count). Splenomegaly rarely has any consequences other than when it causes dangerously low platelet counts and leads to bleeding issues.
Thrombocytopenia defined as a platelet count of <150,000 cells/uL
Mild  75,001 - < 150,000
Moderate 50,000-75,000 - Some increased risk of bleeding
Severe < 50,000

Splenomegaly, like any anatomical abnormality, will be seen on any imaging study of the abdomen. Ultrasound, CT or MRI.

Most people with cirrhosis have some amount of splenomegaly which can easily be seen on a CBC lab report as a lower than normal platelet count. Those with more advanced cirrhosis and portal hypertension will typically have more splenomegaly and a lower platelet count.

Like all complications of cirrhosis, since cirrhosis is the underlying cause, only by treating and curing the cirrhosis can the splenomegaly and its low platelet count be resolved.

Hector
6708370 tn?1471490210
Great explanation

Thanks Hector!
683231 tn?1467323017
Hi Hector,
You said only by curing cirrhosis cirrhosis can splenomegaly be resolved. I have been trying to find information on cirrhosis reversal with cure of hep c. I have apparently mild Thrombocytopenia with my platelet count around 90 and was diagnosed with cirrhosis in Jan 2008.

Would you have an insight about the possibility for cirrhosis to improve with time?

Thanks and Happy Holidays to all
Lynn
446474 tn?1446347682
COMMUNITY LEADER
Hi Lynn,

It typically takes many years for cirrhosis to reverse itself to an earlier stage of disease. IE F3 or lesser stages of liver disease.

The best way to monitor the improvement of your liver disease (cirrhosis) over time is by using Fibroscan or a similar testing method. It can detect degrees of liver disease (range from 2.5 kPa to 75 kPa) unlike a biopsy which can only classify stages of liver disease.

The bottom line:
90,000 platelets is plenty of platelets for blood clotting so there should be no impact on your health from this degree of thrombocytopenia. Many cirrhotic patient and post transplant patient live with asymptomatic thrombocytopenia (platelet count <150,000/μL). I only have about 100,000 platelets myself since my transplant, having had a platelet count in the 60,000 – 70,000 range for many years before my transplant. I have had many invasive procedures including a bone marrow biopsy on Monday without any related bleeding issues because of my lower than normal platelet count. Before any procedure that could cause bleeding, platelet counts and INR are always taken in all patients to assess bleeding safety issues. Obvious drugs that can effect clotting such as aspirin, heparin or warfarin and like meds should only be used under a doctor's care.

Numerous studies have shown that a sustained virological response (SVR) from HCV leads to decreased mortality, morbidity and improved quality of life, as well as a reduced incidence of liver disease progression, including liver failure, cirrhosis and hepatocellular carcinoma (HCC). Large clinical trials comparing pre- and post-treatment liver biopsies demonstrate improvements in inflammation as well as fibrosis score following SVR. However, a small subset of patients display persistent hepatic inflammation and/or progress to cirrhosis despite SVR. In addition to conferring a risk of fibrosis progression, advanced fibrosis pre-treatment is a major risk factor for post-SVR hepatocellular carcinoma.

There is clear evidence that patients with advanced fibrosis or cirrhosis who achieve SVR remain at heightened risk for HCC. So the most important thing anyone who has achieved SVR while having cirrhosis is to continue surveillance for HCC. The number of years surveillance for HCC post SVR is currently not known so surveillance should continue until we learn when the increased risk is ends.

Further clarification of mechanisms for liver repair and regeneration after virological cure of HCV is necessary to maximize improvement in long-term outcomes of HCV infected patients. New data should be available in the coming years now that we have treatments that can cure hep C in cirrhotic patients.

As always, talk to your hepatologist about any particulars (prognosis, other health risks) that pertain to your individual diagnosis and history of cirrhosis.

Happy holidays!
Hector
1 Comments
Thanks Hector
I guess we will be the patients providing that data we are the pioneers.

Happiest of Holidays to you and those you care about!
Lynn
Avatar universal
Enlarged spleen (splenomegaly) can be detected on physical exam in theory, but this may be limited by patient body habitus and/or orientation of spleen. Ultrasound can provide a rough assessment of spleen size. CT and MRI are more accurate. A normal spleen measures 9-13 cm, whereas an enlarged spleen measures greater than 13 cm in greatest dimension.
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