In acute =splenitis= there is generally a blocking up of the smaller
splenic arteries by fibrous coagula (hemorrhagic infarct), which
have formed in the left ventricle of the heart in consequence of
endocarditis. Malarial infections, septicemia, typhus and acute
exanthematous fevers may cause coagula formation in the splenic veins.
Injuries to the vertebræ or ribs on the left side over the spleen
(ninth to eleventh ribs inclusive) are occasionally the predisposing
cause of primary inflammation of the spleen. Following the formation of
abscesses the entire organ may suppurate; it may produce pyemia, or it
may burst and the pus be discharged into the peritoneal sac, causing
peritonitis, or into the pleura, stomach or colon. =Chronic splenitis=
is induced by passive congestion, leukocythemia and splenic anemia.
=Symptoms.=—Tenderness and enlargement of the spleen are the principal
symptoms. The organ may be twice its normal size, but in a few cases
the tumefaction is so insignificant that it can hardly be found on
percussion. Dull pain generally exists if the enveloping membrane or
adjacent organs are involved, the pain being increased upon percussion
and deep inspiration. In a few cases the pain radiates to the left
shoulder and if the peritoneal covering is involved, a sharp pain will
be present. Fever and rigor follow if suppuration has taken place,
and peritonitis follows in case of rupture or perforation. Marked
hypertrophy and chronic inflammation may cause cough, nausea, vomiting
and dyspnea.
=Treatment.=—In the treatment of both the disease producing splenitis,
and of primary splenitis, a thorough treatment of the spine, eighth to
the eleventh dorsal, is necessary. The nerves (vasomotor) to the spleen
are from the left splanchnics, consequently treatment of the left side
is more effectual. Particular attention should be given the ribs over
the spleen—the ninth, tenth and eleventh—as disorders of these ribs
are a common cause of splenic disturbances. Careful and fairly firm
treatment is always indicated, care being taken not to add irritation
to an already inflamed organ, and especially beware that force is not
used where there is danger of rupture. Stimulation of the tenth nerve
contracts the spleen. In cases of suppurative splenitis the direct
treatment should not be given.
Stimulating treatment over the spleen, as over the liver and kidneys,
gives tone to the strong elastic capsule surrounding it, so that direct
manipulation over these organs, coupled with the power of the strong
elastic capsule and highly elastic tissue of the inner organ, will
greatly aid in lessening the engorgement and hyperemia. In a few cases
where the spleen is involved, lesions are found in the upper cervical
which affect the right pneumogastric nerve and thus impair the normal
activity of the gland.