Hepatosplenomegaly - is the simultaneous increase in the parameters of the spleen and liver, have a common way of drainage of lymphatic fluid, venous blood and innervation.In fact, in their practice doctors do not use the diagnosis "hepatosplenomegaly" as increase in the metric parameters of liver and spleen is a manifestation of an underlying disease.Thus, it is advisable to use the term "syndrome of hepatosplenomegaly", including a whole range of clinical and pathological signs.
Hepatosplenomegaly in adults can be triggered by a variety of pathological changes in the human body, and each of them belongs to one of the main etiopathogenic categories.The first and primary category of pathological conditions that lead to the violation of the outflow of venous blood through the portal vein unchanged constitute diffuse liver disease as cirrhosis, hepatitis, fatty liver.Also, the process of venous circulation can adversely affect any cardiac path
not so common infectious nature hepatosplenomegaly, but in the presence of infection in the body pathogens of malaria, brucellosis, leishmaniasis, and infectious mononucleosis increases the risk of changes in diffuse parenchymal liver and spleen, inevitably provoking an increase in their size.Isolated hepatosplenomegaly liver occurs in diseases accompanied by metabolic disorders in the form of amyloidosis and hemochromatosis.
Symptoms and signs of hepatosplenomegaly
Despite the diversity of clinical manifestations of hepatosplenomegaly, there is only one absolute diagnostic criterion for confirming the presence of the disease state of the patient - a significant or moderate increase in the parameters of the spleen and liver.
Patients hepatosplenomegaly, often complain about the presence of a constant discomfort, drawing pains in the right subcostal projection, as well as strengthening of the pain when a sharp change in body position.Note that mild hepatosplenomegaly in most cases is accompanied by specific clinical symptoms and the discovery of the existence of the enlarged size of the spleen and liver of the patient is necessary at the time of instrumental examination of the patient (ultrasound scan of the abdominal computed tomography).
When considering the pathogenesis of hepatosplenomegaly established pattern in the ordering of increasing the size of the liver and spleen.Almost 80% of the patient has an initial increase in the size of the liver (first left its share), as the main category of patients with hepatosplenomegaly are persons with chronic diffuse changes of the hepatobiliary system.In this situation, the development of hepatosplenomegaly is secondary reactive.The only situation in which the initial notes and even an isolated increase in spleen options are available in patients with systemic blood diseases as leukemia, Hodgkin's disease, and hemolytic anemia, because the spleen refers to the main structure of the reticuloendothelial system.
The clinical symptoms in patients with hepatosplenomegaly the fore not the symptoms associated with enlargement of the liver and spleen, and the manifestations of underlying disease, which is an agent provocateur of these changes.Thus, in patients with chronic heart failure stagnant hepatosplenomegaly often associated with ascites.The presence of free fluid in the abdominal cavity, by the way, makes it difficult to instrumental examination of the patient and have a negative effect on the definition of significant size of the spleen and liver.
In a situation where hepatosplenomegaly develops against the background of diffuse parenchymal liver, clinical symptoms depends on the intensity of cytolytic and cholestatic syndromes.Most often in these cases, patients have expressed jaundice syndrome and asthenovegetative symptom.
hepatosplenomegaly syndrome, occurring against the backdrop of existing patient pathologies of blood, accompanied by the development of hemorrhagic symptom, which is the main manifestation of increased bleeding.
Identify patient hepatosplenomegaly indirect evidence in the form of detection enlarged liver during palpation or percussion, the presence of visual changes in the skin and other clinical manifestations, should be accompanied by further examination of the patient.To clarify the etiology of occurrence of hepatosplenomegaly most informative have laboratory diagnostic methods (biochemical blood analysis with determination of liver function tests, blood count with major blood cells and myelogram, allowing to exclude or confirm the presence of pathology of the hematopoietic system, the definition of specific viral and cancer markers in the blood).
In order to clarify the presence of changes in the structure of the enlarged advisable to use imaging tools.For example, during an ultrasound scan can not detect volume growths in increased enforcement, changes of diffuse character, and to evaluate the presence of damage not only to the general architectonic liver and spleen, and other abdominal organs.To refine studies of the structure of increased organ appropriate to apply the radiation imaging techniques (computed tomography).Contrast angiography allows us to investigate the causes of violation of venous circulation in the liver and spleen, particularly in the portal vein.
In situations where after applying instrumental and laboratory methods your doctor are questions and doubts about the nature of the occurrence of hepatosplenomegaly needed a percutaneous needle biopsy of enlarged with further morphological verification of the diagnosis.
Hepatosplenomegaly the child
Development hepatolienal syndrome in children can be triggered by both the acute pathology and is a manifestation of a chronic disease.Upon detection of the existence of a child increased the size of the spleen and liver, most physicians find it difficult to choose the right tactics of this group of patients.This is due to lack of awareness treating pediatric specialists, as well as a small amount of research in this area.The main risk for the development of hepatosplenomegaly in pediatric patients up to the age of three, as in this period the child is marked maximum contact with infectious agents, which are the most frequent cause of this disease.
In order to evaluate whether the enlarged liver and spleen of a child must have a regulatory framework in relation to the normal size of these bodies, but so far such a clear normative data are not available.Among the etiological factors causing the development of hepatosplenomegaly in children in the neonatal period and early breast period, most often there are various congenital anomalies as congenital cysts, tumors of volume, as well as congenital fibrosis.The development of hepatosplenomegaly in children are less influenced by changes in cholestatic nature.Frequent provocateurs hepatolienal syndrome in childhood are immune-mediated diseases, and in this situation, primarily to increase the size of the spleen as the main component of the reticuloendothelial system.
separate category in pediatric patients are children who have been so-called "reactive hepatosplenomegaly" developing the island as a macrophage reaction in response to an acute inflammatory processes in the body.In this situation, hepatosplenomegaly syndrome is transient and self-leveled after the removal of the inflammatory focus.In the case of long flow hepatolienal syndrome, the child has generated irreversible changes in the structure of hepatic and splenic parenchyma in the form of proliferation of the interstitial matrix, which inevitably provokes a violation of the fundamental functions of the organs.
Despite the fact that the mere fact of increasing the liver and spleen is not a life-threatening condition the child, finding hepatosplenomegaly is the basis for further verification of the underlying pathology.Already during the initial inspection of routine in the arsenal of every doctor has a technique using which you can determine the presence of hepatosplenomegaly in children.It's enough to master the rules of the palpatsionnogo and percussion examination of the abdominal cavity of the patient.To clarify the application of these techniques hepatosplenomegaly is not enough and it is necessary to use imaging tools.
key to successful treatment of the syndrome of hepatosplenomegaly is to conduct an adequate course of etiopathogenetic therapy, that is, the normalization of the metric parameters of liver and spleen is possible only after the elimination of their causes.Thus, when hepatosplenomegaly, occurring against the backdrop of a viral liver disease, a fundamental element in the course of treatment is the use of antiviral therapy, as a basis for the treatment of viral hepatitis.In congestive heart failure, one manifestation of which is considered to hepatosplenomegaly, basic treatment is the use of diuretics (furosemide 40 mg 1 time a day), with massive ascites paracentesis.
hepatosplenomegaly syndrome Drug treatment is the use of detoxification agents, glucocorticosteroid series, as well as symptomatic therapy.Disintoxication therapy for hepatosplenomegaly is applied reopoliglyukina parenteral administration in a volume of 400 ml or gemodezu of 300 ml.Treatment of the underlying background of the disease, which triggered the development of hepatosplenomegaly should be complemented by means of a basal treatment as immunomodulators (interferon inhalation, 1 ampoule which must be dissolved in 10 ml of water).Note that in autoimmune nature hepatosplenomegaly contrary should be used immunosuppressant therapy (oral azathioprine in the estimated dose of 2 mg per 1 kg of body weight).
To eliminate cholestatic manifestations in patients suffering from hepatosplenomegaly, we recommend the use of short flows holespazmolitikov (Nospanum a daily dose of 0.08 g), as well as cholagogue (Holosas 5 ml 3 times a day), in the absence ofconcretions in the lumen of the gallbladder and bile ducts.As an additional means to treat Syndrome hepatosplenomegaly actively applied hepatoprotective agent (Geptral 0.8 g per day orally), reducing architecture of the liver in combination with probiotic drugs (Latsidofil 2 capsules three times a day).
Hepatosplenomegaly - a doctor will help ?If you have or suspect a developing hepatosplenomegaly should immediately consult a doctor such as a physician, gastroenterology, hematology and infectious diseases.