The spleen is an organ about the size of a fist, situated within the abdominal cavity. It plays a major role in the body’s immune and circulatory systems, filtering blood, removing damaged red blood cells, and storing white blood cells. Pain originating from the spleen signals underlying distress, ranging from chronic infection to acute trauma. Understanding the location and characteristics of this pain helps determine the cause and appropriate care.
Locating Spleen Pain and Associated Symptoms
The spleen is located in the upper left quadrant of the abdomen, tucked beneath the diaphragm and protected by the lower rib cage. Pain often presents as a dull ache or sensation of fullness when the organ is chronically irritated or enlarged. This discomfort may become sharper with movement or when taking a deep breath, as the swollen spleen presses against surrounding structures.
A specific symptom of severe splenic irritation or injury is referred pain, known as Kehr’s sign. This causes pain to be felt at the tip of the left shoulder, not the abdomen. The sensation occurs because the phrenic nerve, which supplies the diaphragm near the spleen, shares nerve pathways with the nerves transmitting sensation from the shoulder.
Tenderness to the touch in the upper left abdomen is a common sign of splenic involvement. Because a dysfunctional spleen can press on the stomach, some individuals feel full after eating only a small amount of food. Localized symptoms may be accompanied by non-specific signs like fever, fatigue, or unexplained weight loss.
Acute Causes: Injury and Rupture
The most immediate cause of spleen pain is blunt force trauma to the abdomen, leading to a splenic injury or rupture. Since the spleen is a soft, highly vascular organ, a forceful impact (such as from an accident or sports injury) can tear the protective capsule. This tear causes rapid internal bleeding into the abdominal cavity.
A ruptured spleen is a medical emergency due to the risk of hemorrhage and shock. The pain is typically sudden, sharp, and severe in the upper left abdomen. Substantial bleeding can quickly cause circulatory instability, including a rapid heart rate, lightheadedness, and a drop in blood pressure.
In some cases, the rupture may be delayed, occurring hours or days after the initial injury, which may have seemed minor at the time. This delay happens when a blood clot initially contains the bleeding, but the weakened splenic capsule eventually gives way. Any abdominal pain following a forceful trauma requires immediate medical assessment to check for splenic damage.
Chronic Causes: Enlargement and Underlying Conditions
A common cause of splenic pain is splenomegaly, or enlargement of the organ, which is usually a secondary symptom of another underlying disease. Pain results from the organ stretching its fibrous outer capsule as it swells, triggering pain receptors. Enlargement is triggered by conditions that cause the spleen to overwork or become congested.
Infections frequently cause enlargement as the spleen ramps up its immune function to fight pathogens. Infectious mononucleosis, caused by the Epstein-Barr virus, is a known example that causes substantial swelling as it produces large numbers of lymphocytes. Other infections, such as bacterial endocarditis, malaria, or abscesses, also lead to hyperactive immune responses causing swelling and pain.
Liver diseases are another contributor, primarily through portal hypertension. When severe liver scarring (cirrhosis) obstructs blood flow through the liver, pressure builds up in the portal vein system draining into the spleen. This back-pressure causes blood to pool, leading to chronic congestion and enlargement.
Blood disorders can also cause the spleen to enlarge as it attempts to filter abnormal blood components. Conditions like hemolytic anemia cause the spleen to work overtime destroying prematurely aged red blood cells, leading to swelling. Blood cancers, such as leukemia and lymphoma, can infiltrate the spleen with malignant cells, increasing its size and causing persistent discomfort.
When to Seek Immediate Medical Attention
Recognizing signs that require urgent medical intervention is important when experiencing pain in the splenic region. Any sudden onset of severe, sharp pain in the upper left abdomen, especially following an injury, should be treated as a medical emergency. This suggests an acute event, such as a splenic rupture, which carries a high risk of internal hemorrhage.
Other serious signs warranting an immediate visit include symptoms of shock, such as feeling dizzy, faint, or weak. A rapid heart rate, shallow breathing, and paleness indicate significant blood loss may be occurring. Additionally, if existing mild pain suddenly worsens, or if the pain radiates to the left shoulder, professional medical evaluation is required immediately.