hepatosplenomegaly: the enlargement liver and spleen

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 hypochondrium and epigastrium, abdominal pain on palpation. Diagnosis is based on the detection of large sizes of the spleen and liver during a clinical examination, ultrasound and MRI of the abdominal organs. There is no specific treatment for hepatosplenomegaly; this syndrome is resolved against the background of therapy for the underlying disease.

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, the patient does not show other clinical manifestations of any disease. Such cases require long-term observation, timely re-examinations to identify the pathology that caused hepatosplenomegaly.

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, even and elastic. In pathology, the properties of the hepatic margin change: in cardiovascular diseases, it becomes round and loose; with oncological – 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:

• damage to the liver tissue (acute or chronic diffuse inflammation, the formation of regenerative nodes, fibrosis , intra- or extrahepatic cholestasis , tumors, cysts , etc.)
• cardiovascular diseases (chronic heart failure against the background of coronary artery disease , hypertension and heart defects, constrictive pericarditis , hepatic vein endophlebitis)
• parasitic infestations . In patients with hepatosplenomegaly, various infectious diseases are often found ( malaria , leishmaniasis, brucellosis , mononucleosis )
• anomalies of the vessels of the liver and portal system .
• hemoblastosis . The development of this syndrome is also very likely in case of blood diseases ( leukemia , severe anemia, lymphogranulomatosis )
• storage diseases ( hepatosis of various etiologies, hemochromatosis , amyloidosis )

At the beginning of the underlying disease, only the spleen (with pathology of the blood system) or only the liver (with hepatitis and other diseases of the liver tissue) can be enlarged. The combined lesion of these two organs is due to the common system of blood supply, innervation and lymphatic drainage. That is why, in severe diseases, only hepatomegaly or splenomegaly can initially be recorded, and as the pathology progresses, both of these organs are inevitably affected with the formation of hepatosplenomegaly.

The symptomatology of hepatosplenomegaly is largely determined by the underlying disease, which led to an increase in the liver and spleen. Isolated hepatosplenomegaly is characterized by a feeling of heaviness and fullness in the right and left hypochondrium, the definition of a rounded formation protruding from under the costal arch (edge ​​of the liver or spleen). In the presence of any pathology leading to hepatosplenomegaly, the patient presents complaints characteristic of this disease.

A rapid increase in the liver is characteristic of viral hepatitis , oncopathology. Severe soreness of the hepatic margin during palpation is inherent in inflammatory liver diseases and malignant neoplasms, and in chronic pathology it appears during an 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 against the background of severe 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).

A gastroenterologist can suspect hepatosplenomegaly during a routine examination: during palpation and percussion, enlarged liver and spleen are detected. Such a simple research method as percussion (percussion) makes it possible to differentiate the prolapse of the abdominal organs from their true increase.

Normally, with percussion of the liver, its upper limit is determined at the level of the lower edge of the right lung. The lower border starts from the edge of the X rib (along the right anterior axillary line), then passes along the edge of the costal arch on the right, along the right parasternal line – two centimeters below the costal arch, along the midline – 5-6 cm below the xiphoid process, the boundaries of the liver are not extend beyond the left parasternal line. The transverse size is 10-12 cm, gradually tapering 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 percussion difficult). Normally, splenic dullness is determined between the IX and XI ribs, is about 5 cm in diameter, the length should not exceed 10 cm.

Palpation of the abdominal organs is a more informative method. It should be remembered that a tumor of the right kidney, colon, gallbladder can be taken for an enlarged liver. Emphysema , subdiaphragmatic abscess , right-sided pleurisy can provoke hepatoptosis , due to which 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. The spleen should be palpated in the position on the right side. Simulate splenomegaly can prolapse of the left kidney, tumors and cysts of the pancreas , neoplasms of the colon .

A consultation with a gastroenterologist is indicated for all patients who have hepatosplenomegaly. Diagnostic search is aimed at determining the disease that led to an increase in the liver and spleen. It includes:

• Laboratory research. Clinical blood tests, liver biochemical tests reveal damage to the liver tissue, hematological diseases, viral hepatitis and other infectious and parasitic diseases.
• instrumental visualization. Ultrasound of the abdominal organs , MRI of the liver and biliary tract, MSCT of the abdominal 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.
• Needle 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 establish the diagnosis of liver damage.
• Angiography. It involves the introduction of a radiopaque substance 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 biopsy of the lymph nodes are performed .

The combination of hepatosplenomegaly with changes in liver tests indicates damage to the liver parenchyma, storage diseases. Detection of lymphomyeloproliferative processes, changes in the general blood test indicates hematological pathology. The characteristic symptoms and clinic of damage to the cardiovascular system make it possible to suspect congestive heart failure .

If isolated hepatosplenomegaly is detected, there are no other clinical manifestations and changes in the analyzes, the patient is monitored for three months. If during this time the size of the liver and spleen does not decrease, the patient with hepatosplenomegaly should be hospitalized in the department of gastroenterology 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 the liver function is impaired. Cholagogue drugs, antispasmodics and hepatoprotectors alleviate the condition of a patient with hepatosplenomegaly and improve his quality of life. Pathogenetic therapy of hepatitis is the use of antiviral and hormonal drugs. In case of hematological diseases, chemotherapy can be prescribed , bone marrow transplantation can be performed .

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 developed. Predicting the further development of hepatosplenomegaly is practically impossible due to the multifactorial nature of the formation of this condition. Prevention is to prevent the development of diseases that can lead to an increase in the liver and spleen.