Q. Why do I get occasional liver and spleen enlargement?

Answered by
Dr. Kks
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Mar 28, 2020 and last reviewed on: Apr 07, 2020

Hello doctor,

I have been dealing with some health issues for three years. I had an ultrasound before showing my spleen was mildly enlarged to 12.8 cm. Since then I have had on and off spleen enlargements. Last week I had an ultrasound with again a mild spleen enlargement at 12.8 cm. Sometimes the spleen returns to a normal size of 11.8cm. I have also noticed in my ultrasound that my liver was enlarged to 16.8 cm when my liver was previously normal at 15.5 cm.

I have also done a bunch of blood work and my bilirubin levels went to 27 when they should be below 20 and my conjugated bilirubin was 9 when it should be below 7. I have had my ALT and AST testing and all is fine there. I have had my CBC and differential and all is good with this too. I am very concerned about what this could be and what is happening to my body. My doctor is sending me to a hematologist, please help me to understand what is happening. If this is cancer or something serious. Please help.

Dr. Kks

General Medicine Hematology Internal Medicine


Welcome to icliniq.com.

I hope you are safe.

I reviewed your doctor's report. (attachment removed to protect patient identity).

While I can understand your concern, but as of there is no one pick and choose a reason for your case. To be frank, I am not bothered by your spleen size or liver size. Yes, they are close to the above normal range. I do not know if you have some component of fatty liver, your USG (ultrasound) may tell you that. If you drink alcohol? Do you think it is worth trying to see what happens to the size?

Sometimes we take a few medicines which tend to increase the bilirubin, etc. Examples are OCPs (oral contraceptive pills), birth pills. There are many more. Just get your medicine list reviewed by your PCP. Easy bruisability over the skin, do you have gum bleeds as well? But your platelet count is well above the normal range as well. Do you have any family history of bleeding and do you have excessive menstrual bleeding?

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Thank you doctor,

Are you a hematologist? I have never been told I have fatty liver, would an ultrasound show the fatty liver? My liver has gone down to 15.5 cm recently. I do not drink any alcohol and I eat very healthy and keep fit. I am not on any medication and I never even take Advil or anything. I am very clear with no medication or birth control. My gums do bleed a lot yes. Did you see my platelet count? No excessive menstrual bleeding. I have been referred to a hematologist because the doctor is concerned that my spleen is inflamed on and off for over three years.

Dr. Kks

General Medicine Hematology Internal Medicine


Welcome back to icliniq.com.

Yes, USG (ultrasound) can tell about fatty liver. But it seems that you have no other reason for your bilirubin elevation.

Gum bleeding is something that could be due to as easy as due to vitamin C deficiency and many patients do complain about easy bruisability. But still, your spleen 12.8 which is just high normal will not explain that. I am just trying to fit everything into one.

For teaching purpose, when the spleen is large, sometimes it eats up the platelet from the blood. But your is not that low to cause low platelet related bleeding.

In females, sometimes autoimmune disease also sit quietly till they present with uncommon features. Did you get checked your coagulogram anytime by your PCP. You can try Vitamin C meanwhile in case that helps. For autoimmune disease, I would start by getting an ANA (antinuclear antibody) level checked.

All the above things can be done by PCP. I am sorry but we have to run tests only to know your problem better if you have any.

I hope this helps.

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