Archived Forum: Is This Normal? > enlarged spleen

Hi Gwyn!

So I have an update from the doctor. Just to recap, I went to the doctor because I had a stabbing pain under my lower left ribcage (upper left quadrant I guess) and thought that it maybe was from H. Pylori. That came back negative, but the doctor said I had elevated liver enzymes. I was tested for hepatitis, which came back negative as well. However, I was sent for an abdominal ultrasound and it seems as though my spleen is inflamed/enlarged. The doctor is now testing me for infectious mononucleosis, which if I do have the illness (caused by Epstein Barr right?) then that would explain the sudden fatigue even though I am robustly continuing along with my recovery (always 3500+ no exercise, healthy bmi (21+)). Anyways, I started researching enlarged spleen on the internet and well there weren't too many causes except for cancer and some other scary things. There was also no information on recovery and an enlarged spleen. Could the two be related? Also, if the mono blood test comes back negative, what could be the cause? Now that I know my spleen is enlarged if I press on my left side it hurts immensely. Actually it hurts just sitting here, on my couch, doing nothing. Could this also have caused the pain in my stomach and last week pain when I took a breath in that shot up to my shoulder? Ah, sorry for the rant, I'm just a little perplexed as to what is going on with me right now. Any info would be appreciated. Thanks :)

April 18, 2012 | Registered Commentervangirl

Well, the thing is the spleen can enlarge in response to many viral infections but it is true that Epstein-Barr is the most common culprit. EBV has infected the vast majority of our population and although it is linked to the development of two very rare forms of cancer, given that 95% of us have been infected with EBV at one point, clearly cancer is highly unlikely.

Recovery is just like any viral infection: rest and fluids. It can last for many weeks, so you have to be patient and really make rest your full-time job for a while.

And yes, clearly your symptoms appear to be attributable to the enlarged spleen and not any gastrointestinal issues (yay!). Although good thing no exercise right now as enlarged spleens and exercise don't play nicely together at all!

If the tests come back negative it can mean another virus is to blame. It could mean anemia, if they have not already confirmed your red blood cell count is normal of course.

And yes it is possible for the history of a restrictive eating disorder (not so much a recovery effort) to have a role in the development of an enlarged spleen in response to infection because your immune system (like everything else in your body) is damaged by restriction and that can lead to more severe immune responses than we might otherwise see in non-ED otherwise healthy patients.

There is nothing scarier than looking this stuff up on the web and the biggest problem with the information provided is not that it is inaccurate, it is pretty accurate, but it fails to really explain the relative commonness or rareness of various possible causes and that can make anyone very anxious!

Commonly EBV is a viral infection that knocks you back for several weeks and that's that. Rarely is an enlarged spleen the result of anything other the body having to clear out the virus and the antibodies associated with fighting a viral infection.

Presumably your physician has recommended you use NSAIDs to alleviate your pain as much as possible. It's now a waiting game of rest, eat, rest, eat, rest eat.

I hope your symptoms resolve quickly and hope this helps a bit. G.

April 18, 2012 | Registered CommenterGwyneth

Wow thanks so much for the quick response Gwyn (as always). You have definitely put my mind at ease! And yes you are right, it is not a good idea to look on the web, there's so much misleading information on there. I do actually have anemia so that could very well be the issue if the mono test comes back negative. But I guess as you said, rest is the best thing I can do for myself right now. So, after my exams are over that is exactly what I intend to do! I even quit one of my jobs for the summer (the more active one) so that I can basically be a bump on a log for a while (the other one I sit on a chair all day, so yay for that)!. All the best Gwyn :)

April 18, 2012 | Registered Commentervangirl

1) vangirl, when you started recovery, what point were you at? (low bmi? severe restriction?)
how long have you been resting + 3500+ (over 25 by any chance?)

2) okay, so this is exactly what i've experienced the last 2-3 years,,,but doctors have ignored me or unable to find the cause and don't care :(

It is legitmiately (for 2++ years now) a deep "stabbing' pain on the left side (in the EXACT same spot that vangirl described) is what I've complained as being " a stitch" a constant 24-7 stabbing there no matter what...
I always wonder if my extreme sedentarism is making it worse ? (I do walk now and then, but other than that, am sitting reading, writing, dreaming, watching tv, etc)...this has been years now

3) think I'll request an abdominal ultrasound for sure (no harm , no foul, right?) it a quick easy test (or something that you have to drink something nasty for?...barium is yuck)...can a regular GP or nurse practitioner make a requisition for it to be done, or must a Gastroenterologist request it?...

4) i have been anemic...bigtime...but while my iron is rising, my RBC count is still very low

5) A naturopath once theorized that there was something wrong with my spleen actually...but it was a long time ago and it was just a quick consult with her (i couldn't afford anything more since naturopaths cost you an arm and leg just for one visit) that is interesting

6) is there a "cure" ? :) Anything one can do to help oneself? Someone once told me that coldness first thing in the morning can irritate the spleen...but i like cold drinks and fruit in the morning, i wouldn't want to avoid ...

7) i bet bet bet that acupuncture or massage or chiropractic or one or those hands-on techniques would be MIRACULOUS for that...BUT since I couldn't afford that by a long shot, rather than sit in self-pity about not being able to afford it, are there GREAT and effective ways that one can help oneself (to a point of REALLY helping effectively?). I'm all I got, so maybe something?

April 18, 2012 | Registered Commentersara-eats

1) Sara, you have e-mailed me before, but if you do not remember I started recovery from a low bmi (14ish). I am 24 (25 in a few weeks, yay for birthdays!)

2) Really sucks that doctors have ignored your symptoms. You can go to a GP or Nurse practitioner and they will give a requisition I am sure if you ask. I do not think being sedentary is making it worse. As Gwyn mentions above, an enlarged spleen can rupture easily so you would not want to exert yourself in case that happened. I also want to say that I do not have a stitch 24 hours a day. The pain I had previously and described above was more like a stabbing pain in my stomach that was intermittent and possibly caused by the enlarged spleen pushing on my stomach. The actual spleen pain I am describing now is not just under my ribcage, but to the left of it (almost on my side). And it's an ache/soreness almost bruise like pain.

3) Like I said above, you can go to a GP or NP and get a requisition, no need for a GI specialist (you're in Canada right?). It does sound like the pain you have is worth looking into. I never would have thought it was my spleen, so yours very well might be enlarged and causing you more distress.

4) I cannot remember what bmi you are, but if I am correct it is still quite low yes? Your low RBC count is probably due to this (malnutrition is a cause). If you take supplements that may be why your iron levels are rising but your rbc count remains low.

5) Well not sure what the naturopath had in mind. It may be worth checking into so that you can rule out the spleen.

6) I've never heard coldness in the morning can irritate the spleen. I've had smoothies in the morning for years and never had problems with my spleen until now so do not think this is the case. Also, I don't know what you mean by 'cure' because an enlarged spleen is commonly due to a viral infection (since it is part of the lympathic system and thus immune response in your body) or anemia (also in the post above). For me they are testing for mono/Epstein Barr virus. But, as Gwyn has said above, it could just be my body reacting to recovery with an overbearing immune response to any pathogen that has come into my body (from years of being suppressed).

7) I am actually going for an acupuncture treatment tomorrow (first one) so we will see how it goes.

Hope these answer your questions! I think it is hard to tell whether there is something underlying because of your low bmi, but I am sure an abdominal ultrasound is worth getting until you decide to gain more weight.

April 18, 2012 | Registered Commentervangirl

vangirl: interesting thoughts...i will see my NP next week anyway, so i'll request that then.

i can't remember if i asked you before about nighttime binging (and constipation?)...I have both (just then I went massive overdrive on nut butter, 4 tbsps , a tub of yogurt, and a batch of granola...i'm hurting now :(

darn sunbutter is like freaking addictive..i think its the sweetness of it (other nut butters do not tempt me at all, but that damn sunbutter is like crack)

good luck on the acupuncture...i have to confess some jealousy :)

April 18, 2012 | Registered Commentersara-eats