Hepatosplenomegaly is a simultaneous increase in the parameters of the spleen and liver, which have a common way of outflow of the lymphatic fluid, venous blood and innervation. In fact, in their practice, doctors do not use the diagnosis of "hepatosplenomegaly", since an increase in the metric parameters of the liver and spleen is only a manifestation of the underlying pathology. Thus, it is advisable to use the term "hepatosplenomegaly syndrome", which includes a whole range of clinical and pathomorphological features.
Causes of hepatosplenomegaly
Hepatosplenomegaly in adults can be provoked by various pathological changes in the human body and each of them belongs to one of the main etiopathogenetic categories. The first and the main category of pathological conditions leading to violation of the outflow of venous blood through the unchanged portal vein system are diffuse liver diseases in the form of cirrhosis , hepatitis , fatty hepatosis . Also, any cardiac pathology accompanied by chronic congestive heart failure can exert negative influence on the process of venous circulation.
Infectious nature of hepatosplenomegaly is not so common, however, in the presence of an infectious disease of the body, the pathogens of malaria, brucellosis , leishmaniasis and infectious mononucleosis increase the risk of diffuse changes in the liver and spleen parenchyma, which inevitably provoke an increase in their size. Isolated hepatosplenomegaly of the liver occurs in diseases accompanied by metabolic disorders in the form of amyloidosis and hemochromatosis .
Symptoms and signs of hepatosplenomegaly
Despite all the variety of clinical manifestations of hepatosplenomegaly, there is a single absolute diagnostic criterion that confirms the presence of this pathological condition in the patient - a significant or moderate increase in the parameters of the spleen and liver.
Patients suffering from hepatosplenomegaly often complain of the presence of constant discomfort, drawing pains in the projection of the hypochondrium on the right, and also an increase in these painful sensations with a sharp change in the position of the body. It should be borne in mind that moderate hepatosplenomegaly in most cases is not accompanied by the appearance of specific clinical symptoms, and the finding of the presence of enlarged sizes of the spleen and liver in the patient occurs at the time of instrumental examination of the patient (ultrasound scanning of the abdominal cavity, computed tomography).
When considering the pathogenesis of hepatosplenomegaly development, a regularity is established in the orderly increase in the size of the liver and spleen. In almost 80% of cases, the patient has a primary increase in liver size (primarily left lobe), since the main category of patients with hepatosplenomegaly are those suffering from chronic diffuse changes in the organs of the hepatobiliary system. In this situation, the development of hepatosplenomegaly has a secondary reactive character. The only situation in which the primary and even isolated increase in the spleen parameters is noted is the systemic blood diseases present in the patient in the form of leukemia , lymphogranulomatosis and hemolytic anemia , since the spleen belongs to the main structures of the reticuloendothelial system.
In the clinical symptomatology of hepatosplenomegaly in patients, not the symptoms associated with the increase in the size of the liver and spleen, but the manifestations of the background disease, which is the provoker of the development of these changes, come to the fore. Thus, in chronic congestive heart failure , hepatosplenomegaly often combines with ascites. The presence of free fluid in the abdominal cavity, by the way, makes it difficult to conduct an instrumental examination of the patient and adversely affects the determination of the true size of the spleen and liver.
In a situation where hepatosplenomegaly develops against the background of a diffuse lesion of the liver parenchyma, the clinical symptomatology depends on the intensity of the cholestatic and cytolytic syndromes. Most often in these cases, patients have a marked icteric syndrome, as well as an asthenovegetative symptom complex.
The hepatosplenomegaly syndrome, which occurs against the background of the patient's blood pathology, is accompanied by the development of a hemorrhagic symptom complex, the main manifestation of which is increased bleeding.
Detection of indirect signs of hepatosplenomegaly in the patient in the form of detection of an increase in liver size during palpation or percussion, the presence of visual changes in skin integuments and other clinical manifestations should be accompanied by a further examination of the patient. To clarify the etiology of hepatosplenomegaly, laboratory diagnostic methods (biochemical blood analysis with determination of liver function parameters, blood count with counting of basic blood cells and myelogram, allow to exclude or confirm the presence of the pathology of the hematopoietic system, the definition of specific viral and oncological markers in the blood) are the most informative.
To clarify the presence of changes in the structure of enlarged organs, it is advisable to use instrumental imaging techniques. Thus, during ultrasonic scanning it is possible to detect voluminous neoplasms in enlarged organs, changes in diffuse character, and also to assess the presence of damage to the general architectonics not only of the liver and spleen, but also of other organs of the abdominal cavity. For a more accurate study of the structure of an enlarged organ, it is advisable to use radial imaging techniques (computed tomography). Contrast angiography allows to investigate the causes of venous circulation in the liver and spleen, in particular in the portal vein system.
In situations where, after applying the instrumental and laboratory methods, the doctor in charge has questions and doubts about the nature of the onset of hepatosplenomegaly, it is necessary to perform percutaneous fine-needle biopsy of enlarged organs with further morphological verification of the diagnosis.
Hepatosplenomegaly in the child
The development of hepatolienal syndrome in childhood can be triggered as an acute pathology, and be a manifestation of a chronic disease. If a child is found to have an enlarged spleen and a liver, the majority of doctors find it difficult to choose the right tactics for maintaining this category of patients. This fact is explained by the lack of awareness of the treating pediatric specialists, as well as by the small number of scientific studies in this field. The main risk group for the development of hepatosplenomegaly in pediatrics is patients under the age of three, since during this period the child has maximum contact with infectious agents, which are the most frequent cause of this pathology.
In order to assess whether the liver and spleen are enlarged in a child, it is necessary to have a regulatory framework for the normal size of these organs, but to date no such clear normative data are available. Among the etiological factors provoking the development of hepatosplenomegaly in children during the newborn period and early infancy, most often there are various congenital anomalies in the form of congenital cysts, bulky neoplasms, and congenital fibrosis. The development of hepatosplenomegaly in children is less affected by changes in the cholestatic character. Frequent provocateurs of hepatolienal syndrome in childhood are immuno-mediated diseases and in this situation the sizes of the spleen, as the main constituent of the reticuloendothelial system, primarily increase.
A separate category of patients in pediatric practice is children who have the so-called "reactive hepatosplenomegaly", which develops sharply as a macrophage reaction in response to acute inflammatory processes occurring in the body. In this situation, the hepatosplenomegaly syndrome has a transient character and is independently leveled after the inflammatory focus has been eliminated. In the case of a prolonged course of hepatolyenal syndrome, the child develops irreversible changes in the structure of the hepatic and splenic parenchyma in the form of growth of the interstitial matrix, which inevitably provokes a violation of the basic functions of the organs.
Despite the fact that the fact that the liver and spleen is enlarged is not a threatening condition for a child's life, the detection of hepatosplenomegaly is the basis for further verification of the underlying pathology. Even with the initial routine examination in the arsenal of each physician there are techniques that can be used to determine the presence of hepatosplenomegaly in a child. To do this, it is sufficient to master the rules of palpation and percussion examination of the patient's abdominal cavity. To clarify hepatosplenomegaly, these techniques are not sufficient and it is necessary to use instrumental imaging techniques.
Treatment of hepatosplenomegaly
The key to successful treatment of hepatosplenomegaly syndrome is an adequate course of etiopathogenetic therapy, that is, the normalization of the metric parameters of the liver and spleen is possible only after elimination of the causes of their occurrence. So, with hepatosplenomegaly, which occurs against the background of viral liver damage, the main link in the treatment is the use of antiviral therapy, as the basis for the treatment of hepatitis viral etiology. With congestive heart failure , one of the manifestations of which is hepatosplenomegaly, the basic treatment is the use of diuretics (Furosemide 40 mg once a day), laparocentesis with massive ascites.
Drug treatment of hepatosplenomegaly syndrome consists of the use of detoxification, glucocorticosteroid, and symptomatic therapy. Disintoxication therapy for hepatosplenomegaly consists in the application of parenteral administration of Reopoliglyukin in a volume of 400 ml or Hemodeza in a volume of 300 ml. Treatment of the main background disease that triggered the development of hepatosplenomegaly should be supplemented by means of basal therapy in the form of immunomodulators (inhalation administration of Interferon, 1 ampoule of which must be dissolved in 10 ml of water). It should be borne in mind that in the autoimmune nature of hepatosplenomegaly opposite, immunosuppressant therapy should be used (oral imuran intake at a calculated dose of 2 mg per 1 kg of the patient's weight).
In order to eliminate cholestatic manifestations in a patient suffering from hepatosplenomegaly, a short-term use of the funds of the group of choleospasmolytics (No-shpa in a daily dose of 0.08 g), as well as cholagogue (Holosas 5 ml 3 times a day), is recommended, provided there are no concrements in lumen of the gallbladder and bile ducts. As an additional tool in the treatment of hepatosplenomegaly syndrome, hepatoprotective agents are actively used (heptral 0.8 g per day), restoring liver architectonics, in combination with probiotic drugs (Latsidofil 2 capsules three times a day).
? Hepatosplenomegaly - which doctor will help ? If there is or suspected development of hepatosplenomegaly, you should immediately seek advice from such physicians as therapist, gastroenterologist, hematologist and infectious disease specialist.