What Causes Upper Right Abdominal Pain And Enlarged Spleen?

Posted on Wed, 15 Jun 2016

Question: About a year ago i was diagnosed with epstein barr virus. When i was diagnosed i had no symptoms other than an enlarged spleen. I am currently having a flare up. I feel a fullness in my upper right abdomen, and when i laugh i can feel like a stabbing pain. I am afraid that my spleen will get so large it will rupture. :( I have been eating garlic, drinking tea, taking ginger pills. Anything to get this flare up to go away. It's so scary when this happens and I'm not sure what to do. My spleen went up to about 16 or 17cm last time. I think it was the first time i actually had an outbreak. This would be my first flare up since, are flare ups as bad as the initial time? I know not to do any crazy activity. I haven't even been sleeping on my left side. Could it get so big and rupture from a flare up?

Sorry i feel a fullness in my upper left abdomen*

Answered by Dr. Noble Zachariah (50 minutes later)

Brief Answer:
Spleen rupture in EBV infection is rare.

Detailed Answer:
Hello XXXXXXX

Welcome back.
I understand your concern and what you are going through.
EBV infection is very common in people of your age.
You should relax. Spleen is well protected by the rib cage and it has to enlarge more than twice its size to even become palpable. The spleen rupture is very rare and usually occurs in people playing contact games or due to a blunt trauma to the abdomen as occurring in a traffic accident.
Your abdominal symptoms do not have to be due to a flare of EB viral infection. Do you have lymph node enlargements in other areas like the neck?
Eating too much of garlic, ginger and drinking tea and caffeinated beverages increases the chance of gastritis especially when you are stressed. This can lead to abdominal symptoms.
To put your mind at ease get an ultrasound examination of the abdomen to know the size of the spleen.
Do get back to me with further queries if any.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Noble Zachariah (3 minutes later)

Hi thank you for getting back. I am drinking non caffinated tea. I also have pain in my left arm which happened the first time my spleen enlarged. I am wondering if my spleen was 17cm last time is there a possibility it could be bigger during this flare up? It also feels tight where my spleen is when i breathe in and when i push lightly on it its tender.

Answered by Dr. Noble Zachariah (20 minutes later)

Brief Answer:
Welcome

Detailed Answer:
Pain in the left arm was unlikely to be due to enlarged spleen as it is not a common site of pain referred from spleen. Such pains are commonly due to muscular inflammation in viral diseases.
Do you require to see a physician to get an abdominal ultrasound examination done? Here in Kuwait, one can get it done by going directly to the sonologist. This would be helpful in two ways. If the spleen is normal, it relieves your stress. If it is enlarged, other causes also may be looked into.
Take Care

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Noble Zachariah (7 hours later)

I understand and i have considered other causes however I do know the symptoms of when i feel my spleen is enlarged :( last time it happened it didn't go down for 6 months. I am wondering if my spleen was 17cm last time is there a possibility it could be bigger during this flare up?

Also would it be best for me to see an internal medicine doctor or a GP for this. I moved to a new state and need a new doctor.

Thanks so much :)

Answered by Dr. Noble Zachariah (4 minutes later)

Brief Answer:
Good idea

Detailed Answer:
Definitely.
If you have access to a specialist in Internal Medicine, she/he would be the appropriate doctor for you. If not a good GP is fine.
I would be interested in knowing your progress and their findings including the US .
Best wishes and regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Noble Zachariah (36 minutes later)

Okay thank you! I will get back to you with the results but i was also wondering " I am wondering if my spleen was 17cm last time is there a possibility it could be bigger during this flare up?"

Answered by Dr. Noble Zachariah (7 minutes later)

Brief Answer:
Welcome

Detailed Answer:
You would have had lymph nodes enlarged when you had the attack of EBV. These have shrunk with the recovery. Spleen is a large lymphatic organ, it also would have reduced in size with you getting over the infection then. If you are having a flare up and your spleen enlarges, it will be from the size it would have reduced to at the time of recovery. This is assuming that the spleen enlargement was due to EBV infection and not to any other cause.
So don't worry.
When the doctor examines you, she can feel the spleen under the rib cage, if it is significantly enlarged and it moves with the breathing.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Noble Zachariah (1 hour later)

Where can i feel for lymphnodes? I could not get an appointment until next week :( and yes the spleen was enlarged due to ebv i had tons if tests done.

Answered by Dr. Noble Zachariah (42 minutes later)

Brief Answer:
In the neck mainly

Detailed Answer:
Enlarged lymph nodes are felt in the neck mainly, above the collar bones, below the jaw and behind the ear.
You can search for images of lymph node enlargement in EB Virus infection to get a better idea.

Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar