What Is Hepatosplenomegaly?

Hepatosplenomegaly means that the liver and spleen are enlarged. The liver and spleen generally cannot be touched under the ribs. The liver and spleen can be touched only when the viscera sags or the diaphragm is lowered or inhaled deeply, but it does not exceed 1 cm below the ribs and has a soft texture. Hepatosplenomegaly is common in chronic hepatitis, typhoid fever, schistosomiasis, early cirrhosis, leukemia, and drug poisoning. Granulocytic leukemia can be seen with high splenomegaly. The cause should be identified and the primary disease treated in a timely manner.

Basic Information

English name

hepatosplenomegaly

Visiting department

Gastroenterology

Common locations

Liver, spleen

Common causes

Chronic hepatitis, typhoid fever, schistosomiasis, early cirrhosis, leukemia, drug poisoning, etc.

Causes and common diseases of hepatosplenomegaly

Cause of liver disease

fatty liver; hemosiderin-containing disease; glycogen accumulation of liver; hepatolenticular degeneration; schistosomiasis; liver fluke; Toxoplasma gondii; tachyzoomegalovirus infection; rubella virus infection; Viral infection; Congenital biliary atresia; Liver tumors; Liver tumors; Liver disease; Liver hydatid disease; Liver hydatidosis; Liver toxic hepatitis; Liver amyloidosis; Liver portal hypertension disease.

2. Causes of Splenomegaly

Cytomegalovirus infection; Rubella infection; Hepatitis B virus infection; Infectious mononucleosis; Toxoplasmosis; Schistosomiasis; echinococcosis; amyloidosis; gaucher disease; galactose Hyperlipidemia; Fanconi syndrome; splenomegaly; spotting syndrome; mucopolysaccharide type I; Histoplasmosis; Black fever.

3. Common diseases

(1) Hyperlipoproteinemia type is a relatively rare hereditary disorder, manifested as hepatosplenomegaly, tension, and upper abdominal pain.

(2) Hepatic myelopathy, also known as portal-lumen shunt myelopathy, is a special type of neurological complications complicated by liver disease, which is manifested by fatigue, ascites, hepatosplenomegaly, ankle clonus, jaundice, anorexia .

(3) Pediatric aquatic histiocytosis is an autosomal recessive genetic disease. Presented as liver failure, hepatosplenomegaly, jaundice, and deeper skin pigmentation.

(4) Red skin disease, also known as exfoliative dermatitis, is a serious systemic disease manifested by low fever, low blood pressure, liver and spleen, and high fever.

(5) Myelodysplastic syndrome manifests as increased white blood cell count, epistaxis, epistaxis, fatigue, liver and spleen enlargement, etc.

Differential diagnosis of hepatosplenomegaly

Hepatosplenomegaly is not a disease, and the occurrence of hepatosplenomegaly requires consideration of the following diseases.

Chronic inactive hepatitis

Symptoms generally are not much, symptoms do not worsen after the event, occasional fatigue, poor appetite, occasionally right upper quadrant bloating, most of the liver without tenderness, liver function is mostly within the normal range.

2. Cirrhosis

The main clinical manifestations of cirrhosis are liver and splenomegaly, which is extremely common. But exclude diseases that can cause splenomegaly, such as malaria, black fever, and schistosomiasis. Splenomegaly has some significance in diagnosis. Barium meal radiography and / or gastroscopy for the presence of esophageal or gastric varicose veins are extremely valuable in the diagnosis of cirrhosis. Generally, it is not difficult to distinguish chronic hepatitis from medical history, physical signs, liver function tests, imaging tests, etc. Ultrasound examination can help diagnosis, liver biopsy can confirm chronic hepatitis or cirrhosis, but its indications must be strictly controlled.

Hepatosplenomegaly examination

Laboratory tests are very important to determine the cause of liver and spleen enlargement and determine liver function. Sometimes clinical symptoms are not obvious but laboratory tests have shown abnormal liver function.

Blood test

(1) Observation of leukocyte counts and cell morphology of blood elephants has diagnostic value for infectious diseases and leukemia. Hemoglobin and red blood cells decreased, and reticulocytes increased, suggesting hemolytic anemia.

(2) Examination of liver function, examination of liver function, hepatitis B surface antigen (HBsAg), hepatitis B core antigen and E antigen. Alanine aminotransferase and aspartate aminotransferase are also abundant in the heart and muscle tissues. Such enzymes can be released into the bloodstream in large quantities after asphyxia and hypoxia. Lactate dehydrogenase is increased during hepatitis and not increased during obstructive jaundice, suggesting that cholestasis enzymes include alkaline phosphatase, leucine aminotranspeptidase, and -glutamyl transpeptidase. Serum 5-nucleosides Acidase is also significantly increased during biliary atresia.

(3) Etiological examination of blood bacterial culture, virus isolation, and detection of specific antibodies can help determine the types of bacteria and viruses that cause infection.

(4) Other tests such as those suspected of abnormal glucose metabolism should measure blood glucose and glucose tolerance test. In order to confirm the diagnosis of blood group incompatibility hemolytic disease, direct anti-human globulin test, free antibody measurement and antibody release test must be performed. Serum protein electrophoresis, alpha fetal protein, immunoglobulin and other tests can be selected as needed.

2. Bone marrow examination < br Bone marrow aspiration should be done when considering blood diseases or malignant cell proliferation, which is very valuable for the diagnosis of leukemia, thrombocytopenic purpura and malaria.

3. Liver biopsy < br For liver and spleen of unknown diagnosis or suspected tumor, biopsy can be taken after liver and spleen puncture. Such as the diagnosis of primary liver tumors or secondary tumors.

(1) Type B ultrasound examination Ultrasound examination can help determine the size of the liver and spleen. Ultrasound scans can be used to observe the location, shape, and size of the liver, check diaphragmatic motion, and show the relationship between the liver and adjacent organs. Ultrasonography can also provide etiological data. B-mode ultrasound is extremely useful for identifying liver cysts, liver abscesses, and liver tumors. Liver cirrhosis, fatty liver, and congested liver can also be distinguished on ultrasound images. Gallbladder ultrasound can detect the presence of common bile duct cysts. Ultrasound examination can observe the position, shape and size of the spleen, and abdominal muscle tension has little effect on it. Ultrasonography is more sensitive and correct for judging splenomegaly than palpation, and can show internal structure, which can be distinguished from congestive splenomegaly, lymphogranuloma, primary tumor of spleen and subsplenic hematoma.

(2) Radionuclide examination Radionuclide examination can also be used for the diagnosis of hepatosplenomegaly. Colloidal 99mTc is used to understand the location, shape, size of the liver and detect the presence of hepatic lesions in the liver. The spleen can be visualized with the liver at the same time. When the spleen is normal, the spleen shadow is lighter than the right lobe of the liver. When the spleen is hyperactive, the spleen shadow can be thicker than the liver shadow.

Hepatosplenomegaly Treatment Principles

Hepatosplenomegaly is only a common clinical symptom / sign, and the primary disease should be treated in time on the basis of finding out the cause.