Etiology.—This may follow acute splenitis, when it is due to infectious agents. The most frequent cause, however, is malaria, though syphilis and tuberculosis are important factors. Obstruction of the portal circulation by various hepatic diseases is also a common cause of chronic enlargement.
Pathology.—The organ varies greatly as to size, sometimes assuming an enormous bulk, Morro reporting a case where the spleen weighed fifty-five pounds. The surface is generally smooth, dark-colored, and firm in character. A cut section reveals hyperplasia of the stroma and the presence of connective tissue. In other cases the organ is a soft, pulpy mass of degenerated cells. When due to malaria (ague-cake), the organ is of a mottled appearance, or of a dark-red or almost black color.
Symptoms.—Hypertrophy of the spleen may exist for a long time without any subjective symptoms; in fact, may never give the patient any discomfort. When very large, there is a sense of weight and oppression in the left hypochondrium, and if there are firm attachments to the diaphragm or stomach, dyspnea, palpitation, and nausea and vomiting may occur. Where there is much pressure on the vena cava there will be enlargement of the superficial veins of the legs and abdomen, accompanied by more or less dropsy. Pain and tenderness are sometimes a marked feature. Severe colicky pains may result from pressure upon the colon.
Treatment.—The treatment depends largely upon the lesions giving rise to it. When due to obstruction of the portal circulation, remedies will be directed to relieve this condition, podophyllin, leptandra, chionanthus, chelidonium, polymnia, and carduus mariana will be used. If due to syphilis, berberis, corydalis, and the iodides will be given. If the result of malaria, quinia, arsenic, and polymnia will not disappoint. Any agent that will improve the general health—such as tonics, restoratives, etc.—may be administered.
The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.