Clinical Nutrition: The spleen

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Last month, I began a series that will deal with the reticuloendothelial system and each of its component organs. In this column, I'll be covering the spleen.

Among the patients you are seeing today are the following three:

1. A young career woman who complains of fatigue. You notice that her conjunctivae and nail beds are pale and suspect that she is anemic. But, there is also a question of a compromised immune system and you decide to examine her for splenomegaly.
2. A college student with failing appetite, ability to concentrate, energy, and grades. You think he is depressed, and are wondering if a diet high in simple sugars might be a contributing factor. You also want to rule out infectious mononucleosis and decide to examine him for splenomegaly.
3. An elderly hypertensive male complaining of the appearance of "aging spots" who wishes to know what causes them. As he lies on the examining table stripped to his waist, you wonder whether you should take the time to examine him for splenomegaly.

Why examine the spleen?

You palpate for the spleen to see whether you can feel it. Most palpable spleens are enlarged, and splenomegaly in an adult requires an explanation.

Despite the many important causes of splenomegaly (including cancers, infections, and connective tissue diseases) most are relatively uncommon.

Many times when we palpate for the spleen we find only muscle contraction in the overlying abdominal muscles. In the absence of excessive exercise (or trauma), muscle contraction in this area indicates splenic stress. If the stress is continued long enough to exhaust the body's ability to compensate, then the spleen will begin to hypertrophy.

So, you palpate for the spleen not only to rule out splenic enlargement (splenomegaly), but also to identify stress to the organ and to prevent disease. You may also be searching for a possible cause of recurring segmental spinal dysfunction (subluxation) in the area of the 6th to 8th thoracic segments.

Structure and function

In order to identify the reason for splenic stress, I'm going to briefly review its structure and function.

The spleen contains partitions that divide the organ into compartments. These compartments contain a sponge-like network of cells separated by many blood channels called "sinusoids." It is these sinusoids that act as reservoirs for red blood cells.

- Blood storage. The outer covering of the spleen is elastic tissue and smooth muscle and allows the spleen to vary its size considerably. The spleen undergoes rhythmic variations in size in response to physiologic demands, such as exercise and hemorrhage, and thus influences the volume of circulating blood which may vary from 1,000 to as little as 50 ml.

This is a crucial point. For example, the "fight or flight" response of sympathetic stimulation causes the spleen to contract pushing its content of red blood cells into the general circulation for improved oxygenation.

- Blood destruction. Old red blood cells, having reached their normal life span of approximately 120 days, are destroyed in all parts of the reticuloendothelial system, including the lymph nodes and spleen. The spleen, however, is the major site of erythrocyte destruction.

- Blood filtration. As a part of the body's reticuloendothelial defense mechanism, the spleen filters microorganisms from the blood and along with other lymphoid tissues, participates in the immune response.

While an individual can survive with no apparent disability if the spleen has been removed, you can see that diseases affecting the spleen may profoundly affect several important body functions.

Clinical decisions

Going back to our three patients at the beginning of this column, I would suggest that palpation of the spleen for stress or hypertrophy should be considered anytime one of the following syndromes is present:

-- Syndrome 1: The patient complains of fatigue, weakness, or exertional dyspnea, especially (but not only) when accompanied by changes in skin color, pallor or icterus. This syndrome is suggestive of anemia and a complete blood count should be ordered.

Of particular interest to you should be the minutes of the National Institutes of Health workshop held June 3 and 4, 1997. John Beard, Ph.D. presented his findings that "a dietary source of iron is much more effective than a much, much larger dose of ferrous sulfate."

-- Syndrome 2: The patient presents with unexplained or recurrent fever, especially with evidence of splenomegaly or lymphatic enlargements. A complete blood count should be ordered to monitor white blood cell activity. Leucopenia or leucocytosis are both evidence of an increased need for proteolytic enzymes.

-- Syndrome 3: The patient complains of bruising easily or even bleeding gums, especially if accompanied by petechiae or ecchymoses. A complete blood count should be ordered with your attention directed to the platelet count. The findings may prompt further studies of prothrombin times, etc.

Each one of these syndromes will present symptoms as well as physical signs, such as splenomegaly. When correlated with specific spinal findings, they can make you a brilliant diagnostician.

Each one of these syndromes also demonstrates the need for nutritional supplementation to assist the body in maintaining homeostasis (health). When the cause is determined the treatment becomes obvious.

The Chiropractic Journal.

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By Howard F. Loomis

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