What Is an Enlarged Spleen?

Splenomegaly

Splenomegaly can be classified into two major categories: one is infectious splenomegaly; the other is non-infectious splenomegaly. There are many causes of splenomegaly, and the mechanism of splenomegaly is different for each disease. Sometimes the mechanism by which a disease causes splenomegaly may be multiple factors.

Measurement and recording of splenomegaly (in cm):

Line I (also known as A-B line) refers to the distance from the intersection of the left clavicle midline and the left costal margin to the lower edge of the spleen, expressed in centimeters. Slight splenomegaly was only measured on the first line.

The second line (also known as the A-C line) refers to the distance from the intersection of the left midclavicular line and the left costal margin to the furthest point of the spleen, which should generally be greater than the first line.

Line III (also called Dingwu line) refers to the distance between the right edge of the spleen and the anterior midline. If it exceeds the median line, the maximum distance from the spleen to the median line will be measured as a positive value, indicated by "+"; if it does not exceed the median line, the shortest distance from the right edge of the spleen to the median line will be measured as a negative value, indicated by "-".

The splenomegaly was divided into light, medium and high degrees. The spleen margin does not exceed 2cm below the ribs for mild enlargement; if it exceeds 2cm, it is moderately enlarged above the umbilical horizontal line; if it exceeds the umbilical horizontal line or anterior midline, it is highly swollen, that is, giant spleen. At this time, the second line and the third line should be measured.

Causes of Splenomegaly

I. Infectiousness

(A) acute infection

Found in viral infections, rickettsial infections, bacterial infections. Borrelia infection, parasite infection.

(B) chronic infection

Found in chronic viral hepatitis, chronic schistosomiasis, chronic malaria, black fever, syphilis and so on.

Non-infectious

(I) Congestion

Found in liver cirrhosis, chronic congestive right heart failure, chronic constrictive pericarditis or a large number of pericardial effusions Judd-Chiari syndrome, idiopathic non-sclerotic portal hypertension.

(Two) blood diseases

Found in various types of acute and chronic leukemia, red leukemia. Red blood disease, malignant lymphoma, malignant histiocytosis, idiopathic thrombocytopenic purpura, hemolytic anemia, polycythemia vera, myelofibrosis, multiple myeloma, systemic histiocytosis, and hypersplenism disease.

(Three) connective tissue disease

Such as systemic lupus erythematosus, dermatomyositis, nodular polyarteritis, juvenile rheumatoid arthritis (Sill disease) Felty disease and so on.

(IV) Histiocytosis

Such as Letter-siwe's disease, xanthomatosis, (Han Yi Xue Yi Ke) syndrome, eosinophilic granuloma.

(V) Lipid deposition

Such as Gao Xue disease, Nieman's disease.

(6) Spleen tumors and cysts

Spleen malignant tumors are rare in primary cases, and malignant tumors that metastasize to the spleen are also rare. Most of the primary cancers are located in the digestive tract. Spleen cysts are rare and can be classified into true and pseudocysts. True cysts are classified as epidermal cysts, endothelial cysts (such as lymphatic cysts) and parasitic cysts. The pseudocysts of patients with cysts include hemorrhagic, serum or inflammatory.

Splenomegaly mechanism

The mechanism can be summarized as follows:

First, cell infiltration

Splenomegaly caused by cell infiltration is seen in: various inflammatory cell infiltration, eosinophil infiltration, leukemia cell infiltration, and various tumor cell infiltration. Inflammatory cell infiltration is more common in acute infectious diseases, often accompanied by marked congestion of the spleen. Eosinophil infiltration is found in eosinophilia and partial lipid deposition; splenomegaly caused by infiltration of various leukemia cells is most obvious in chronic myelogenous leukemia. The second is chronic lymphocytic leukemia; the lymphocyte type is more obvious in acute leukemia, followed by acute myelogenous leukemia and acute mononuclear leukemia. Various tumor cell infiltrations and malignant tumors of the spleen itself are rare. Malignant tumors that originate in the lymphatic system, bone marrow, and intestine can invade the spleen. For example, lymphoma cells of malignant lymphoma have spleen infiltration. Hodgkin's disease is more involved in the spleen, accounting for about 50%. Occasionally, a simple brand of Hodgkin's disease, which can be manifested as giant spleen Infiltration of bone marrow cancer cells of myeloma; infiltration of malignant histiocytosis of malignant histiocytosis; intestinal malignant tumor metastasis to the spleen, splenomegaly can occur due to infiltration of tumor cells.

Second, spleen stasis

The spleen is the largest blood storage organ in the body. Obstruction of spleen blood flow caused by various reasons can cause congestive enlargement of the spleen. Such as: liver cirrhosis, portal hypertension / venous and inferior vena cava thrombosis, tumor emboli, congenital or acquired vascular malformations; right heart failure, constrictive pericarditis, or a large amount of pericardial effusion caused by various reasons Spleen stasis and swelling.

Third, extramedullary hematopoiesis

The spleen is a hematopoietic organ. During proliferative diseases of the bone marrow, the spleen resumes its hematopoietic function. Extramedullary hematopoietic changes of varying degrees result in spleen enlargement. Extramedullary hematopoiesis is most pronounced during bone marrow fibrosis, and splenomegaly is also apparent.

Fourth, histiocytosis

Histiocytosis is an abnormal proliferation of histiocytic cells, involving multiple organs throughout the body, especially the most prominent in the liver and spleen, lymph nodes, bone marrow, skin, and thymus, which can manifest obvious splenomegaly. Such as: Le Yixue, Han * Xue Yike's disease / chronic infectious disease, black fever, connective tissue disease, fellty, Still disease, rheumatoid arthritis, etc. can cause spleen tissue cell proliferation and spleen month old.

Five, fibrous tissue hyperplasia

Due to long-term chronic stimuli such as chronic chronic congestion, chronic infection, and cell infiltration, the abnormal proliferation of tissue cells causes a large number of fibrous tissues in the spleen to enlarge and harden the spleen.

Six, dysmetabolic disorders

Due to the lack of lipid metabolism enzymes or dysfunction, lipid metabolism disorders are caused, and lipids are deposited in tissues causing splenomegaly. Such as: Gaucher's disease is an autosomal recessive lipid-like metabolic disorder. It is because the glucose encephalase cannot convert the glucose encephalopathy to galactocerebroside, and as a result, a large amount of brain lipid accumulates in the tissue cells, and the chronic type shows giant spleen. Niemann-Pick disease is a mononuclear macrophage tissue that affects internal organs with lipid metabolism disorders. This disease may be due to the lack of neurophospholipase, which causes the accumulation of neurophospholipids in liver and spleen and macrophages of the nervous system, causing the spleen to significantly increase.

7. Tumors and cystic expansion of the spleen itself are rare, and primary malignant lymphomas of the spleen are reported. Cystic dilatation is seen in dermoid cysts, lymphatic cysts, and parasitic cysts (cysticercosis). Pseudocysts such as malaria and schistosomiasis can be caused by bleeding and inflammation. Caused by serum sex and other reasons.

Splenomegaly related diseases

Primary liver cancer Bile duct cancer Biliary cirrhosis Cardiogenic liver cirrhosis Fatal intrahepatic cholestasis syndrome Primary liver cirrhosis syndrome Glycogen accumulation Felty syndrome Shunt hyperbilirubinemia syndrome Liver- Neonatal hemolytic disease of thyroid syndrome neonatal hepatitis syndrome endocardial elastofibrosis hyperplasia spleen-hepatic syndrome idiopathic non-sclerotic portal hypertension syndrome pediatric tuberculosis congenital rubella neman-Pick's disease blood group incompatibility Hemolytic disease, Cytomegalovirus infection, neonatal sepsis, measles, portal hypertension, pigmented urticaria, malaria, black fever, brucellosis, rabbit fever, leukemia, AIDS, cytomegalovirus infection, congenital giant cell inclusion disease, bone marrow fibrosis, bone marrow, anemia, vitamin B12 deficiency Anemia due to anemia due to folate deficiency Anemia due to anemia Congestive splenomegaly Congenital erythrocyte membrane disease Thalassemia lymphopenia Idiopathic hypereosinophilic cell syndrome Langerhans cell histiocytosis macroglobulin Kaposi's sarcoma Gaucher's disease return to fever histoplasmosis Mycococcosis primary thrombocytopenic purpura Idiopathic thrombocytosis, true erythrocytosis, autoimmune hemolytic anemia, dystrophic cirrhosis, myelodysplastic syndrome, chronic lymphocytic leukemia, chronic myeloid leukemia, glucose-6-phosphate dehydrogenase deficiency, and spleen hyperfunction Syndrome abnormal hemoglobin disease Zinc deficiency typhoid and paratyphoid non-alcoholic fatty liver disease acute abdominal-hyperlipidemia syndrome nutritional megaloblastic anemia hypersplenism Park-Chaz syndrome Buka syndrome aflatoxin Poisoning mucopolysaccharidosis softening plaque vascular injury protein-energy malnutrition pediatric allergic subsepticemia syndrome pediatric non-lipid reticular endothelial proliferation syndrome pediatric amyloidosis neonatal ABO hemolytic disease neonatal prolonged cholestatic jaundice Pediatric liver cirrhosis, children with hepatic encephalopathy, children with congenital leukocyte granule abnormality syndrome, cytomegalovirus pneumonia, chlamydia pneumoniae, neonatal cytomegalovirus infection, congenital rubella syndrome, congenital syphilis, neonatal coxsackievirus B infection, neonatal congenital Toxoplasma infection in newborns with herpes simplex virus infection in newborns B Neonatal acquired immunodeficiency syndrome neonatal hepatosplenomegaly large and small infants with restricted cardiomyopathy neonatal hemorrhagic anemia elderly viral hepatitis elderly alcoholic liver disease elderly hepatic encephalopathy infectious endocarditis elderly Hemolytic anemia

Splenomegaly preventive care

Most patients with splenomegaly need to treat their primary disease rather than removing the spleen. Patients who lose their spleen are more susceptible to severe systemic infections caused by capsulate bacteria (e.g. Haemophilus influenzae, pneumococcus), and the spleen The indications for resection and radiation therapy must be strictly controlled.