Definition:—An inflammation of the spleen, which may be acute or chronic in character, or which may terminate in splenic abscess.
Etiology:—In acute splenitis the condition occurs most commonly as the result of malarial fever; also as the result of typhoid, typhus and relapsing fevers. It follows smallpox, erysipelas, pneumonia, peritonitis, endocarditis and purulent inflammation of any organ.
Symptomatology:—There is a sensation of fulness, pressure or weight in the left hypochondrium, with the evidences of enlargement of the organ upon palpation and percussion. There is some discomfort, but little pain or tenderness, unless the serous covering of the organ is involved in the inflammation (perisplenitis). The conditions from pressure may produce palpitation or dyspnea, or a peculiar irritating cough. If fever be present, it is probably due to the primary condition from which the splenitis has occurred, and the character of the fever will depend upon that condition. If the inflammation terminates in necrosis of tissue and abscess, the fever may be due solely to that fact. If the abscess should rupture, sudden pain is then a marked symptom. This may be located in the region of the stomach, into which abscess of the spleen has ruptured. If this should occur it will immediately be followed by vomiting of blood and pus, and by great prostration.
Diagnosis:—The diagnosis of actual inflammation will be more or less difficult, as every case of enlargement of the organ cannot be said to be an inflammation.
Prognosis:—The curability of this disorder depends upon the curability of the disease which induces it.
Treatment:—Palliative measures alone may be all that is necessary as far as the treatment of this organ is concerned, provided skilful treatment be directed to the disease which has induced the inflammation. Belladonna and bryonia will antagonize local hyperemia and the premonitory symptoms of acute inflammation. They do much toward preventing the development of this disorder. The circumstances under which it arises are those of depraved, vitiated blood, and alteratives with anti-periodics are always needed.
Where splenic disorders are associated with those of the liver, I have obtained the happiest of results by the use of the specific liver remedies, carefully selected. Scudder laid great stress upon the action of polymnia uvedalia in enlargement of the spleen, and other observers have confirmed his conclusions, especially upon that form induced by chronic malaria. The remedy has not received the attention it seems to deserve. Grindelia, ceanothus, chelidonium, carduus marianus and potassium iodid exercise a curative influence in diseases of the spleen. These remedies may be selected in the treatment of chronic enlargement of the organ from whatever cause. They are especially active when, as stated, the disease is due to obstruction of the portal circulation. If the chronic enlargement is due to malaria, periodical manifestations should be treated with quinin, or with the ferrocyanid of iron, especially if anemia be present; or with arsenic, for its constitutional influence, in addition. Abscess of the organ must be freely opened and irrigated.
Other conditions of the spleen which are occasionally found are infarction, which is due to the fact that the terminal arteries or the arterioles are obstructed from the influence of other inflammations, notably from ulcerative endocarditis, or from septic thrombus in the splenic veins, from protracted fever. This may result in abscess, and should be treated for that condition.
Hydatid cysts of the spleen are seldom observed. Although not an impossible condition, it is not capable of diagnosis without an exploratory operation.
Tumors or malignant growths of the spleen are very rare. They may be granulomata, melanotic sarcoma, secondary carcinoma, or lymphadenoma. They are always secondary, and as the attention is usually directed to the primary condition, they are seldom discovered during life. Where cancer has been plainly located in the pylorus, or in the region of the gall bladder, and later similar symptoms develop in the region of the spleen, the involvement of that organ may be inferred during life.