Hepatosplenomegaly is a secondary pathological syndrome that accompanies the course of many diseases and is characterized by a significant simultaneous increase in the size of the liver and spleen. Clinical manifestations depend on the pathology that led to this condition, common signs are heaviness in the hypochondria and epigastrium, abdominal pain during palpation. Diagnosis is based on the detection of large sizes of the spleen and liver during clinical examination, ultrasound and MRI of the abdominal organs. There is no specific treatment for hepatosplenomegaly, this syndrome resolves against the background of therapy of the underlying disease.
ICD 10
R16.2 Hepatomegaly with splenomegaly, not classified elsewhere
Meaning
Hepatosplenomegaly, or hepatolienal syndrome, is one of the clinical manifestations of various pathological conditions. Most often, a significant increase in the liver and spleen is detected during a screening examination or examination of the patient for other diseases. Hepatosplenomegaly is not a separate nosological unit, but only a syndrome of a certain pathology. Most often it occurs in the age group up to 3 years – this is due to the increased frequency of intrauterine infections and oncopathology in children. Quite often, in the presence of hepatosplenomegaly, no other clinical manifestations of any disease are detected in the patient. Such cases require long-term follow-up, timely repeated examinations to identify the pathology that caused hepatosplenomegaly.
Hepatosplenomegaly causes
Diseases of the hepatobiliary system or pathology of other organs can lead to hepatosplenomegaly. Normally, the edge of the liver can be palpated in healthy people, it is sharp, smooth and elastic. In pathology, the properties of the hepatic margin change: in cardiovascular diseases, it becomes rounded and loose; in oncological diseases, it becomes hard, bumpy. The lower edge of the spleen is normally not palpable.
In newborns, the most common cause of hepatosplenomegaly is hemolytic disease, in young children – intrauterine infections and oncological pathology. in adults, the cause of hepatomegaly can be various pathological conditions. Most often it is:
- liver tissue damage (acute or chronic diffuse inflammation, formation of regenerative nodes, fibrosis, intra- or extrahepatic cholestasis, tumors, cysts, etc.)
- cardiovascular diseases (chronic heart failure on the background of coronary heart disease, hypertension and heart defects, constrictive pericarditis, endophlebitis of hepatic veins)
- parasitic invasions. Patients with hepatosplenomegaly often have various infectious diseases (malaria, leishmaniasis, brucellosis, mononucleosis)
- abnormalities of the vessels of the liver and portal system.
- hemoblastosis. The development of this syndrome is also very likely in blood diseases (leukemia, severe anemia, lymphogranulomatosis)
- accumulation diseases (hepatoses of various etiologies, hemochromatosis, amyloidosis)
At the beginning of the underlying disease, only the spleen can be enlarged (with pathology of the blood system) or only the liver (with hepatitis and other diseases of the liver tissue). The combined lesion of these two organs is caused by a common system of blood supply, innervation and lymph outflow. That is why in severe diseases, initially only hepatomegaly or splenomegaly can be registered, and as the pathology progresses, both of these organs are inevitably affected with the formation of hepatosplenomegaly.
Hepatosplenomegaly symptoms
The symptoms of hepatosplenomegaly are largely determined by the background disease, which led to an increase in the liver and spleen. Isolated hepatosplenomegaly is characterized by a feeling of heaviness and swelling in the right and left hypochondrium, the definition of a rounded formation protruding from under the costal arch (the edge of the liver or spleen). In the presence of any pathology leading to hepatosplenomegaly, the patient presents complaints characteristic of this disease.
Rapid enlargement of the liver is characteristic of viral hepatitis, oncopathology. Pronounced tenderness of the hepatic margin during palpation is inherent in inflammatory liver diseases and malignant neoplasms, and in chronic pathology appears during exacerbation or due to the addition of purulent complications.
A significant increase in the spleen is possible with cirrhosis, thrombosis of the splenic vein. A characteristic symptom of thrombosis is the development of gastrointestinal bleeding on the background of pronounced splenomegaly. With varicose veins of the esophagus, the size of the spleen, on the contrary, is significantly reduced against the background of bleeding (this is due to a decrease in pressure in the portal vein system).
Diagnostics
A gastroenterologist may suspect hepatosplenomegaly during a routine examination: during palpation and percussion, enlarged liver and spleen are detected. Such a simple method of research as percussion (tapping) makes it possible to differentiate the omission of abdominal organs from their true enlargement.
Normally, with liver percussion, its upper border is determined at the level of the lower edge of the right lung. The lower border begins from the edge of the X rib (along the right anteropodmuscular line), then passes along the edge of the costal arch on the right, along the right parasternal line – below the costal arch by two centimeters, along the median line – 5-6 cm below the xiphoid process, the borders of the liver do not go beyond the left parasternal line. The transverse size is 10-12 cm, gradually narrowing to the left edge to 6-8 cm.
Percussion of the spleen can present certain difficulties due to its small size and close proximity to the stomach and intestines (the presence of gas in these organs makes tapping difficult). Normally, splenic dullness is defined between the IX and XI ribs, is about 5 cm across, the length should not exceed 10 cm.
Palpation of the abdominal organs is a more informative method. It should be remembered that an enlarged liver can be mistaken for a tumor of the right kidney, colon, gallbladder. Emphysema of the lungs, subdiaphragmatic abscess, right-sided pleurisy can provoke hepatoptosis, which is why the lower edge of the organ will be palpated significantly below the edge of the costal arch, although the true dimensions will not be increased. Palpation of the spleen should be performed in the position on the right side. Splenomegaly can be imitated by omission of the left kidney, tumors and cysts of the pancreas, neoplasms of the colon.
A gastroenterologist’s consultation is indicated for all patients who have hepatosplenomegaly. The diagnostic search is aimed at determining the disease that led to the enlargement of the liver and spleen. It includes:
- Laboratory test. Clinical blood tests, biochemical liver tests can detect liver tissue damage, hematological diseases, viral hepatitis and other infectious and parasitic diseases.
- Instrumental visualization. Ultrasound of the abdominal cavity organs, MRI of the liver and biliary tract, CT of the abdominal cavity organs allow not only to accurately diagnose the degree of enlargement of the liver and spleen in hepatosplenomegaly, but also to detect concomitant pathology of other abdominal organs.
- Puncture biopsy of the liver. In difficult diagnostic situations, under local anesthesia, the liver tissue is punctured with a thin needle and the material is taken for histological examination. This technique is invasive, but allows you to accurately diagnose liver damage.
- Angiography. It involves the introduction of an X-ray contrast agent into the vessels of the liver and spleen, followed by an assessment of their architectonics and portal blood flow.
- Other punctures and biopsies. If a hematological pathology is suspected, a bone marrow puncture and a lymph node biopsy are performed.
The combination of hepatosplenomegaly with changes in liver samples indicates a lesion of the liver parenchyma, accumulation diseases. The detection of lymphomyeloproliferative processes, changes in the general blood test indicates hematological pathology. The characteristic symptoms and the clinic of the cardiovascular system lesion make it possible to suspect congestive heart failure.
Hepatosplenomegaly treatment
If isolated hepatosplenomegaly is detected, there are no other clinical manifestations and changes in the analyzes, the patient is monitored for three months. If the size of the liver and spleen does not decrease during this time, the patient with hepatosplenomegaly should be hospitalized in the gastroenterology department for a thorough examination and determination of treatment tactics. Measures for hepatosplenomegaly are aimed at treating the underlying disease, and symptomatic therapy is also carried out.
To improve the patient’s condition, detoxification therapy is carried out – it allows you to remove toxic metabolic products from the body that accumulate when liver function is impaired. Choleretic drugs, antispasmodics and hepatoprotectors alleviate the condition of a patient with hepatosplenomegaly and improve his quality of life. The pathogenetic therapy of hepatitis is the use of antiviral and hormonal drugs. In case of hematological diseases, chemotherapy may be prescribed, bone marrow transplantation may be performed.
Prognosis and prevention
Hepatosplenomegaly is a formidable syndrome that requires mandatory treatment for highly qualified medical care. The prognosis depends on the underlying disease, against which the hepatolienal syndrome has developed. Predicting the further development of hepatosplenomegaly is almost impossible due to the multifactorial nature of the formation of this condition. Prevention consists in preventing the development of diseases that can lead to an increase in the liver and spleen.