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[[File:Illu_spleen.jpg | thumb| upright=1|The human spleen is located in the upper left abdomen, behind the stomach ]]
'''Spleen pain''' is a pain felt from the left upper [[abdominal pain|quadrant of the abdomen]] or [[epigastrium]] where the human [[spleen]] is located or neighboring. <ref name="Ami Meital Ella Abraham p=e1363"/>
==Etiology==
===Splenomegaly===
Splenomegaly can result in hematologic disturbances and abdominal pain and can increase the risk for [[splenic rupture]], which also causes spleen pain, from blunt trauma, resulting in life-threatening [[internal bleeding]]. <ref name="Zambrano Samson Phares Jentes pp. 1358–1362">Liquid error: wrong number of arguments (1 for 2)}}</ref> Many conditions can cause splenomegaly, such as various [[infection]]s, [[liver disease]], and [[cancer]]. <ref name="Zambrano Samson Phares Jentes pp. 1358–1362"/>
===Splenic infarction===
Abdominal pain remains the leading chief complaint in patients diagnosed with a splenic infarct. <ref name="Ami Meital Ella Abraham p=e1363">Liquid error: wrong number of arguments (1 for 2)</ref> Evaluation of patients who present with abdominal pain requires a broad differential approach. <ref name="Chapman Bhimji 2018 p. "/>
Lab evaluation may help rule in other causes of abdominal pain. Elevated [[liver function test]]s, [[bilirubin]] or [[lipase]], may suggest a [[hepatobiliary]] or [[pancreatic]] source for pain. [[Leukocytosis]] and elevated [[lactate dehydrogenase]] (LDH) may be found in splenic infarction. However, these results lack specificity to splenic infarct. <ref name="Chapman Bhimji 2018 p. "/>
Radiographic testing is required to detect this rare illness. In the hyperacute phase of infarction, abdominal CT scan performed with intravenous contrast is the imaging modality of choice in suspected splenic infarction. Splenic infarct appears as a wedge-shaped area of splenic tissue with the apex pointed toward the [[helium]] and the base of the [[splenic capsule]]. As the infarction matures, the affected tissue may normalize, liquefy or become contracted or scarred. [[Abdominal ultrasound]] has also been used to detect splenic infarction. Ultrasound findings of the hypoechoic wedge-shaped region of splenic tissue indicate infarction. Evolution of infarction may appear as hyperechoic with retraction of the splenic capsule. <ref name="Chapman Bhimji 2018 p. "> }}</ref><ref name="Hwang Lee pp. 1094–1100">Liquid error: wrong number of arguments (1 for 2)</ref>
===Splenic abscess===
[[Fever]] is the most common symptom of splenic abscess, followed by [[abdominal pain]] and a tender mass on [[palpation]] of the left upper quadrant of the abdomen. The common signs and symptoms described of a splenic abscess include the triad of fever, left upper quadrant tenderness, and [[leukocytosis]] is present only in one-third of the cases.<ref name="CC">}}</ref>
===Splenic rupture===
Trauma is the most common mechanism of splenic rupture, and blunt trauma involving the left-upper [[Quadrant (abdomen)|quadrant]], left [[rib cage]], or left [[Flank (anatomy)|flank]] should raise suspicion for splenic involvement. The absence of substantial trauma cannot exclude the possibility of splenic injury, as individuals with a history of [[splenomegaly]] require less force for traumatic rupture.<ref name="Reinhold Melonakos Lyman pp. 190–193">Liquid error: wrong number of arguments (1 for 2)</ref><ref name="Akoury Whetstone 2018 p. ">}}</ref>
Severally ill patients may present with [[hypovolemic shock]] manifesting as [[tachycardia]], [[hypotension]], and [[pallor]]. Other findings include [[Tenderness (medicine)|tenderness]] to [[palpation]] in the left upper quadrant, generalized [[peritonitis]], or [[referred pain]] to the left [[shoulder]] ([[Kehr sign]]).<ref name="Söyüncü Bektaş Cete 2012 pp. 87–8"></ref> Kehr sign is a rare finding and should increase the suspicion of the [[peritoneal]] process and possible splenic rupture. Some patients also report ''[[pleuritic]] left-sided [[chest pain]]'' in the setting of a ruptured spleen. Caution should be used early in the evaluation of patients with a concerning mechanism of injury, since few symptoms may be present early in the course of splenic rupture.<ref name="Oh Mentzer Abuzeid Holsten 2016 pp. e223–4"></ref><ref name="Akoury Whetstone 2018 p. "/>
It is important to ask focused questions regarding previous [[surgical history]], [[hepatic disease]] process, recent [[infection]]s, [[anticoagulant]], [[aspirin]] or [[nonsteroidal anti-inflammatory drugs]] usage and [[bleeding disorder]]s. Visual inspection for signs of external trauma such as [[Abrasion (medical)|abrasion]]s, [[laceration]]s, [[contusion]]s, and classic [[seatbelt sign]] on the abdomen is helpful. The absence of external visual findings does not exclude intra-abdominal pathology, as up to 20% of patients with intra-abdominal injury may not display these findings upon initial examination. Also, examination on arrival may not reveal severe tenderness, [[Rigidity (neurology)|rigidity]], or [[abdominal distention]] in spite of [[Ruptured spleen|rupture]].<ref name="Blaivas Quinn 1998 pp. 627–30"></ref> Physical examination may also be limited in a patient with altered mental status or distracting injuries.<ref name="Monti 2016 pp. 31–34"></ref>Therefore, the physical exam alone is not always sensitive when evaluating a patient with a splenic rupture. <ref name="Akoury Whetstone 2018 p. "/>
==Reference==
[[Category:Spleen (anatomy)]]
'''Spleen pain''' is a pain felt from the left upper [[abdominal pain|quadrant of the abdomen]] or [[epigastrium]] where the human [[spleen]] is located or neighboring. <ref name="Ami Meital Ella Abraham p=e1363"/>
==Etiology==
===Splenomegaly===
Splenomegaly can result in hematologic disturbances and abdominal pain and can increase the risk for [[splenic rupture]], which also causes spleen pain, from blunt trauma, resulting in life-threatening [[internal bleeding]]. <ref name="Zambrano Samson Phares Jentes pp. 1358–1362">Liquid error: wrong number of arguments (1 for 2)}}</ref> Many conditions can cause splenomegaly, such as various [[infection]]s, [[liver disease]], and [[cancer]]. <ref name="Zambrano Samson Phares Jentes pp. 1358–1362"/>
===Splenic infarction===
Abdominal pain remains the leading chief complaint in patients diagnosed with a splenic infarct. <ref name="Ami Meital Ella Abraham p=e1363">Liquid error: wrong number of arguments (1 for 2)</ref> Evaluation of patients who present with abdominal pain requires a broad differential approach. <ref name="Chapman Bhimji 2018 p. "/>
Lab evaluation may help rule in other causes of abdominal pain. Elevated [[liver function test]]s, [[bilirubin]] or [[lipase]], may suggest a [[hepatobiliary]] or [[pancreatic]] source for pain. [[Leukocytosis]] and elevated [[lactate dehydrogenase]] (LDH) may be found in splenic infarction. However, these results lack specificity to splenic infarct. <ref name="Chapman Bhimji 2018 p. "/>
Radiographic testing is required to detect this rare illness. In the hyperacute phase of infarction, abdominal CT scan performed with intravenous contrast is the imaging modality of choice in suspected splenic infarction. Splenic infarct appears as a wedge-shaped area of splenic tissue with the apex pointed toward the [[helium]] and the base of the [[splenic capsule]]. As the infarction matures, the affected tissue may normalize, liquefy or become contracted or scarred. [[Abdominal ultrasound]] has also been used to detect splenic infarction. Ultrasound findings of the hypoechoic wedge-shaped region of splenic tissue indicate infarction. Evolution of infarction may appear as hyperechoic with retraction of the splenic capsule. <ref name="Chapman Bhimji 2018 p. "> }}</ref><ref name="Hwang Lee pp. 1094–1100">Liquid error: wrong number of arguments (1 for 2)</ref>
===Splenic abscess===
[[Fever]] is the most common symptom of splenic abscess, followed by [[abdominal pain]] and a tender mass on [[palpation]] of the left upper quadrant of the abdomen. The common signs and symptoms described of a splenic abscess include the triad of fever, left upper quadrant tenderness, and [[leukocytosis]] is present only in one-third of the cases.<ref name="CC">}}</ref>
===Splenic rupture===
Trauma is the most common mechanism of splenic rupture, and blunt trauma involving the left-upper [[Quadrant (abdomen)|quadrant]], left [[rib cage]], or left [[Flank (anatomy)|flank]] should raise suspicion for splenic involvement. The absence of substantial trauma cannot exclude the possibility of splenic injury, as individuals with a history of [[splenomegaly]] require less force for traumatic rupture.<ref name="Reinhold Melonakos Lyman pp. 190–193">Liquid error: wrong number of arguments (1 for 2)</ref><ref name="Akoury Whetstone 2018 p. ">}}</ref>
Severally ill patients may present with [[hypovolemic shock]] manifesting as [[tachycardia]], [[hypotension]], and [[pallor]]. Other findings include [[Tenderness (medicine)|tenderness]] to [[palpation]] in the left upper quadrant, generalized [[peritonitis]], or [[referred pain]] to the left [[shoulder]] ([[Kehr sign]]).<ref name="Söyüncü Bektaş Cete 2012 pp. 87–8"></ref> Kehr sign is a rare finding and should increase the suspicion of the [[peritoneal]] process and possible splenic rupture. Some patients also report ''[[pleuritic]] left-sided [[chest pain]]'' in the setting of a ruptured spleen. Caution should be used early in the evaluation of patients with a concerning mechanism of injury, since few symptoms may be present early in the course of splenic rupture.<ref name="Oh Mentzer Abuzeid Holsten 2016 pp. e223–4"></ref><ref name="Akoury Whetstone 2018 p. "/>
It is important to ask focused questions regarding previous [[surgical history]], [[hepatic disease]] process, recent [[infection]]s, [[anticoagulant]], [[aspirin]] or [[nonsteroidal anti-inflammatory drugs]] usage and [[bleeding disorder]]s. Visual inspection for signs of external trauma such as [[Abrasion (medical)|abrasion]]s, [[laceration]]s, [[contusion]]s, and classic [[seatbelt sign]] on the abdomen is helpful. The absence of external visual findings does not exclude intra-abdominal pathology, as up to 20% of patients with intra-abdominal injury may not display these findings upon initial examination. Also, examination on arrival may not reveal severe tenderness, [[Rigidity (neurology)|rigidity]], or [[abdominal distention]] in spite of [[Ruptured spleen|rupture]].<ref name="Blaivas Quinn 1998 pp. 627–30"></ref> Physical examination may also be limited in a patient with altered mental status or distracting injuries.<ref name="Monti 2016 pp. 31–34"></ref>Therefore, the physical exam alone is not always sensitive when evaluating a patient with a splenic rupture. <ref name="Akoury Whetstone 2018 p. "/>
==Reference==
[[Category:Spleen (anatomy)]]
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