The first signs and causes of splenomegaly in children. The first signs and causes of splenomegaly in children Moderate splenomegaly

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Every organ human body has an individual shape and size. Normally, these characteristics are approximately the same for different people, however, the development of a particular disease can lead to changes in indicators.

For example, a pathological decrease or, conversely, an increase in an organ is by no means a rare phenomenon.

Splenomegaly - what is it?

Sometimes you can hear from a doctor that a patient has an enlarged spleen or “splenomegaly.” It is difficult for people far from medicine to understand this issue: is it a diagnosis or what is it? Splenomegaly– this is an abnormal enlargement of the spleen associated with the occurrence of any pathological process in the body and is not an independent disease. In simple words- this is a symptom, increased.

The symptom itself is not dangerous, but in any case, an in-depth diagnosis aimed at identifying the causes is required.

Normally, the length of the spleen does not exceed 12 cm in an adult; this organ weighs about 100-150 grams and is not detectable by palpation. The only exceptions are very thin people.

Moderate splenomegaly is an enlargement of the spleen, in which its length is in the range of 13-20 cm and its weight is 400-500 grams. If these values ​​begin to exceed the threshold levels of 21 cm and 1000 grams, respectively, they speak of a severe form.

IN human body The spleen performs a hematopoietic function and is one of the main blood depots, which contains red blood cells, platelets and leukocytes. In addition to producing red blood cells, this organ is responsible for the production of white blood cells - leukocytes. This is how the immune function of the spleen is realized.

However, in this organ not only blood cells are formed, but also damaged and old ones are destroyed. The spleen is also responsible for the synthesis of certain protein structures, in particular immunoglobulins.

Splenomegaly in adults can occur when the body seeks to compensate for the deficiency of certain components. For example, with anemia caused by low hemoglobin in the blood, or with a powerful immune response, when the spleen produces a huge amount of immunoglobulin. In addition, many infections cause mild splenomegaly.

Splenomegaly in children, features

If an enlarged spleen in adults is a possible signal about the development of a pathological process in the body, then splenomegaly in children is not always a cause for concern.

Normally, the spleen of some babies may slightly exceed the maximum threshold values ​​taking into account age. Thus, in a newborn, a deviation in the length of this organ of up to 30% is considered acceptable. By the age of six months, the spleen can exceed the maximum threshold length by 15%, and by three years it can differ from the norm by only 3%.

If a baby is diagnosed with splenomegaly, he must be prescribed full complex diagnostic procedures. You need to pass the general and biochemical analysis s blood, examine urine, conduct a stool examination - a coprogram.

Since common cause enlarged spleen in children are helminthic infestations and infections, examination of stool for worm eggs, immunological analysis for the presence of protozoa and bacteriological examination blood to identify the infectious agent and its drug resistance.

The doctor receives basic data on the degree of enlargement of the organ, its structure, the presence or absence of neoplasms in it after an ultrasound scan of the spleen. Treatment will be required if any pathologies that trigger the development of splenomegaly are identified.

However, there are situations when an enlarged spleen in a child is not a sign of pathology. This symptom is just a reason for a serious examination, but not necessarily a warning about the danger of a serious illness.

Signs and forms of splenomegaly, symptoms

Splenomegaly, as noted above, is not a disease, but possible symptom pathology. The main causes of splenomegaly are infections, autoimmune conditions, diseases of the blood and hematopoietic organs, circulatory disorders, metabolic disorders, abscesses, infarctions of the organ and neoplasms in it.

Infections leading to an enlarged spleen can be caused by pathogens of various natures:

• bacteria;
• viruses;
• protozoa;
• helminths;
• fungi.

Infections

The cause of splenomegaly can be a bacterial infection occurring in acute or chronic form. An enlarged spleen is observed in the following acute conditions:

• sepsis;
• miliary tuberculosis;
• diseases from the typhoid-paratyphoid group, the causative agents of which are Salmonella microorganisms.

In addition, splenomegaly is observed with chronic course syphilis, brucellosis, splenic tuberculosis. In the latter case, predominant damage is observed only in a specific organ, whereas with syphilis other structures also suffer.

Viruses

Talking about viral infections leading to enlarged spleen, mention should be made of measles, hepatitis, and infectious mononucleosis. With measles and rubella, a rash covers the body, pathological changes are additionally observed in the lymph nodes.

Hepatitis viruses primarily infect the liver; the spleen is affected secondarily. She being immune organ, provides enhanced fight against the pathogen and increases with chronic hepatitis.

The development of infectious mononucleosis caused by is associated with damage not only to the spleen, but also to the liver and lymph nodes in the neck.

Protozoa

Protozoal infections are most common in tropical countries. Splenomegaly is most often caused by malaria and leishmaniasis. In the first case, pathological processes affect not only the spleen, but also other organs.

With leishmaniasis, the liver also suffers, and severe skin damage is possible. Another protozoal disease, common not only in southern latitudes, is toxoplasmosis - with this pathology, people suffer nervous system. Toxoplasmosis is often asymptomatic.

• Splenomegaly is recorded with acute form infections.

Infections, helminthic infestations, as well as abscesses and areas of infarction in the organ cause inflammatory enlargement of the spleen. In this case, the signs of splenomegaly are as follows:

• high body temperature (39-40˚С, sometimes up to 42˚С with typhoid, malaria, leishmaniasis, histoplasmosis, blastomycosis, echinococcosis);
• vomiting, nausea;
• sometimes diarrhea;
• pain in the left hypochondrium;
• painful palpation of the spleen.

However, in addition to inflammatory, enlargement of the spleen can also be non-inflammatory. This is typical for him clinical picture:

• normal body temperature or its slight increase (not higher than 37.5˚C);
• unexpressed, mild pain on palpation of the spleen;
• pulling discomfort in the left hypochondrium;
• rapid onset of satiety during meals, as the spleen compresses the stomach.

Non-inflammatory splenomegaly is observed with different types anemia, metabolic disorders of a congenital or acquired nature, portal hypertension, Pick's cirrhosis (involving, in addition to the liver, the heart and lungs), leukemia, lymphoma, myelofibrosis and autoimmune processes ( rheumatoid arthritis, systemic lupus erythematosus, periarteritis nodosa).

In addition, the spleen enlarges without accompanying inflammatory process with the development of tumors and cysts.

Since the clinical picture of non-inflammatory splenomegaly is nonspecific and rather blurred, a complete diagnosis is required to identify the pathology-cause. comprehensive diagnostics, including both laboratory and instrumental methods research.

How to treat splenomegaly?

Question - what is splenomegaly and how to treat it? — first of all arises in a person when he hears such a “strange” diagnosis for the first time. Since this condition develops against the background of some pathology, therapy should be carried out aimed at eliminating the root cause.

At infectious process caused by bacteria, antibiotics are indicated, and if the disease has viral etiology– antiviral drugs.

Mycoses are treated antifungal agents, and helminthic infestations - anthelmintic. With echinococcosis, when cysts with larval forms of the pathogen grow into the spleen, it is only possible surgical removal.

Against the background of anemia, especially caused by vitamin B12 deficiency, vitamin therapy is indicated. Oncological diseases blood is treated with antitumor drugs. To relieve severe inflammation of the spleen and suppress an overly activated immune system, hormonal drugs are used.

Unfortunately drug treatment splenomegaly does not always give results. If there is no positive dynamics and the spleen continues to grow in size, a malfunction in its functioning leads to excessive destruction of blood cells (hypersplenism) - surgical removal of the organ is indicated.

• The same tactics are followed when a malignant tumor is detected.

Possible complications

Splenomegaly requires careful attention from the patient and regular monitoring by the attending physician, especially if it develops against the background chronic infection. Most dangerous complication When the spleen enlarges, it ruptures. It can be caused by increased physical activity, bruises, injuries received, including while playing contact sports.

In addition, splenomegaly is characterized by hypersplenism - increased filtration of blood cells with subsequent destruction. Against this background, a deficiency of red blood cells, platelets and leukocytes develops, and compensatory hyperplasia (overdevelopment) of the bone marrow is formed to restore the normal concentration of blood cells.

It is undesirable to leave splenomegaly without diagnosis, since this can miss the development of serious, often life-threatening diseases.

It happens that during examination in patients with an enlarged spleen and without any clinical manifestations can't find any reason for this pathological condition. This result is not a reason to stop diagnosing. The examination should be repeated after 6-12 months.

Which doctor should I contact if my spleen is enlarged?

The spleen is an organ of the hematopoietic and immune systems, so if splenomegaly develops, you should visit a hematologist and immunologist. However, the initial examination can be carried out by a therapist. This specialist will palpate the organ and, if necessary, prescribe ultrasound diagnostics and laboratory tests.

With the results obtained, the patient can be referred to a specialist. In addition to a hematologist and immunologist, this could be an infectious disease specialist, an oncologist or a surgeon.

I hope I explained what splenomegaly is and it became clear that an enlarged spleen in a child or adult is not a reason to panic. Pathology in children under 3 years of age in the absence of disease is a variant of the norm. For adults, if the cause of organ enlargement has not been found, they should undergo regular diagnostic tests. This way you will be able to protect yourself from complications of splenomegaly itself and identify dangerous ailments in time.

The spleen is an important organ located in the abdominal region and is responsible for immunity. It is here that the destruction of harmful cells, as well as bacteria that are transported through the circulatory system, occurs. In addition, the formation of new blood cells and the destruction of old ones occurs in the spleen, and immunoglobulins are also produced.

In normal condition, the spleen weighs about 100-150 g, and its length ranges from 11 cm to 12 cm. It is very difficult to palpate the spleen, but in children and thin people it is easier to detect it by palpation.

Splenomegaly is a condition in which the spleen is excessively enlarged. The causes of this pathological process can be many phenomena and diseases.

An enlarged spleen in children is not always a reason to worry. Sometimes this process can be observed due to age-related changes in a child. So in newborn babies, the length of the spleen can exceed the norm by about 30%. By six months, its length usually does not exceed 15% of normal, and by 3 years the size of the spleen can increase by only 3%.

Pay attention! If a specialist identifies splenomegaly in a child or suspects this condition, a set of diagnostic measures is mandatory to determine how enlarged the spleen is relative to the norm, and what caused its abnormal enlargement.

In cases of suspected splenomegaly, the following diagnostic measures must be prescribed:

1. General blood test.
2. Biochemical blood test.
3. Urinalysis.
4. Coprogram (study of calla lilies).
5. Palpation of the abdomen - the specialist assesses the density of the spleen, its approximate size, and pain during examination.
6. Ultrasound of the spleen.
7. Coagulogram.
8. Immunological analysis.
9. Bacteriological blood test.

It may also sometimes be necessary to investigate computed tomography or magnetic resonance imaging.

Attention! If, as a result of the above studies, any abnormalities or pathologies in the body that provoke splenomegaly are discovered, specialists will prescribe the necessary treatment for the child.

Splenomegaly in adults

Diagnosis of this anomaly in adults begins with collecting anamnesis and listening to the patient’s complaints. In an adult, abnormal growth of the above organ can be a sign of the development of many diseases.

Their classification is as follows:

• autoimmune diseases;
• accelerated death of red blood cells;
• congestive processes in the spleen;
• various tumors in the body.

Pay attention! The above pathological process may be moderate - in this case, the spleen does not exceed 13-20 cm in length, and its weight does not exceed 1 kg. If the length and weight of the organ are greater than the indicated figures, this condition refers to a severe form of splenomegaly.

An initial examination to determine abnormalities in the development of the spleen can be carried out by a general practitioner.

The above pathological phenomenon can have two forms:

1. Inflammatory– characterized by an increase in temperature, painful sensations on the left side, vomiting, diarrhea and general intoxication of the body.
2. Non-inflammatory– determined only nagging pain on the left, which can radiate to the stomach. In this case, inflammation of the organ tissue does not occur, but its basic functions significantly deteriorate. An increase in body temperature up to 37˚C may be observed.

Pay attention! In most cases, in order to diagnose the above abnormal enlargement of the spleen and identify the causes of this condition of the organ, consultations with hematologists, oncologists and immunologists, and sometimes rheumatologists, endocrinologists and infectious disease specialists are recommended.

Causes of splenomegaly in adults and children

In adults and children, the reasons for an enlarged spleen can be due to: various reasons. We consider the most common of them in the table.

Reasons for the development of splenomegaly

In adults	In children
Abscesses (ulcers on the spleen)	Tuberculosis
Forming cysts	Congenital heart defect
Thrombosis of the frontal and splenic vein	Rickets
Tumors	Typhoid fever
Mononucleosis (at the same time accompanied by enlarged cervical lymph nodes)	Insufficient filling of the spleen with blood
Sepsis (blood infection by pathogenic microbes)	Blood diseases
Fungal infections	Rubella
Anemia (anemia, in which the level of a protein responsible for transporting oxygen in the blood throughout the body decreases)	Hepatitis
Acute and chronic infections	Helminths
Rheumatoid arthritis	Leukemia

In some cases, abnormal enlargement of the organ may occur when taking certain medicines or if you have certain genetic diseases.

Symptoms of abnormal enlargement of the spleen in children and adults

A slight enlargement of the spleen in adults and children can be recognized by the following external signs:

1. Fatigue.
2. Decreased performance.
3. Weakening of the immune system.
4. Sudden weight loss.
5. Restlessness during sleep.
6. The appearance of bruises on the skin and its paleness.

Pay attention! With moderate enlargement of this organ, no manifestations of splenomegaly may be observed at all. Pulling is occasionally possible painful sensations on the left side of the body.

In cases where the organ is enlarged significantly in relation to normal parameters, both a child and an adult may experience a number of the following symptoms:

• rapid onset of a feeling of fullness while eating (the reason for this is the pressure of the enlarged spleen on the stomach);
• impassable pulling, uncomfortable and sometimes painful sensations in the left hypochondrium;
• tachycardia and heart murmurs;
• mild painful sensations when palpating the spleen;
• nausea, vomiting;
• sudden increase in temperature (often up to 39-40 ˚С and above).

Attention! If an enlarged spleen was detected by a specialist, but clinical reasons provoked this phenomenon were not detected during the diagnosis, in no case should this situation be left to chance. The next examination must be repeated 6 months after the first.

Possible complications

The abnormally increasing size of the spleen begins to process red blood cells much faster than usual. This process can cause the development of anemia in an adult or child. The processing of platelets and leukocytes also occurs at an accelerated rate, which leads to a weakening of the immune system and increases the possibility of acquiring any disease.

Also, increased filtration and destruction of blood cells can provoke their deficiency in the body, which can cause the development of hyperplasia - abnormal development of the bone marrow in order to restore the normal number of blood cells.

This condition is dangerous due to the high probability of rupture of the spleen - this is especially true for children due to their mobility. A splenic rupture can be caused by:

• injuries;
• falls;
• bruises;
• excessive physical activity.

Parents whose children have abnormal growth of the spleen need to very carefully monitor the health of their child and his daily well-being in order to notice deterioration in time and contact specialists.

Abnormal growth of the spleen can also provoke a worsening of the disease that originally caused the development of splenomegaly (for example, it can provoke an increase in tumors).

Should splenomegaly be treated?

Splenomegaly is not a disease, but only a clear sign development of any abnormalities in the body. Therefore, the goal of specialists is to identify the reasons that provoked this state of the organ.

If infectious pathologies are detected, treatment in a hospital is necessary. For any diseases circulatory system A thorough, long-term examination of the patient’s blood and the entire body is carried out, specialists draw up a complex treatment plan and, most likely, in this case, the patient will need to be hospitalized several times.

Attention! It is absolutely pointless to direct treatment to reduce the spleen itself, since if the main cause of the development of splenomegaly remains unresolved, this organ will increase again and again.

Depending on what disease caused the development of the anomaly, the patient may be prescribed the following drugs:

• antitumor– if the cause of abnormal growth of the spleen is a tumor: “ Methotrexate"(treatment of leukemia in adults and children, as well as breast cancer in women), " Bruneomycin"(antibiotic for the treatment of neuroblastoma, Wilms tumor and lymphogranulomatosis), " benzoteph"(prescribed when lung cancer or mammary glands); " Degranol"(indicated for lymphocytic leukemia, myeloid leukemia and lymphogranulomatosis);
• hormonal– in order to relieve inflammation and suppress immunity: “ Prednisolone» related to glucocorticoid drugs. It must be taken continuously for 3 to 6 months (decided by a specialist depending on the situation) without exceeding a dose of 20-40 g per day as prescribed by the attending physician;
• antibacterial– when the cause of spleen growth is bacterial infections: “ Adefovir» with hepatitis B; " Chloroquine" And " Pyrimethamine» for malaria; " Azithromycin" And " Clarithromycin"with mononucleosis;
• antifungal– if the cause of splenomegaly is fungal diseases: « Claforan», « Fluconazole», « Nystatin», « Ampioks».

Only with complete relief from the diseases that provoked the abnormal enlargement of the spleen will its size return to normal.

In parallel with the treatment of the underlying disease that provoked splenomegaly, specialists use methods that help reduce the spleen to normal size. For this purpose use:

1. Transfusions of leukocyte and platelet masses.
2. Drug treatment - the patient is prescribed depending on the cause that provoked splenomegaly.

In cases where all the causes of excessive enlargement of the above organ have been eliminated, but nevertheless the spleen continues to actively increase in size, experts insist on its removal. When advanced tumors are detected, it is also often recommended surgery to remove the spleen.

This procedure may cause sharp decline immunity in humans, therefore patients who have undergone organ removal are necessarily prescribed a course of antibiotics and measures aimed at immunizing the body. After undergoing surgery, a person needs to monitor daily diet. It should contain food products enriched with vitamins.

Preventive measures

Prevention of excessive enlargement of the spleen can only be aimed at avoiding the occurrence of diseases that provoke splenomegaly. It is recommended to avoid infectious foci and ensure compliance with hygiene rules.

You also need to strengthen the body’s protective barriers, lead a healthy lifestyle, and refuse bad habits and try to stick healthy eating. Timely vaccination and periodic preventive examinations by a specialist (at least during clinical examination 1-2 times a year) play an important role.

In cases of the occurrence of a particular disease, contact specialists in a timely manner, do not delay treatment and strictly follow the recommendations of doctors. An untreated or neglected disease can lead to serious problems with health.

It will be useful to take courses of multivitamins from time to time, but this should be done only after consultation with a specialist and strictly according to his instructions.

Video - Detailed information about the spleen

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Definition and reasons

The weight of the spleen, even normally, can vary to a greater extent than any other organ, increasing by 2 times, so establishing a threshold from which an enlarged spleen should be considered splenomegaly is always somewhat arbitrary.

Normally, the weight of the spleen in an adult is 100-150 g, but most doctors believe that splenomegaly begins with its increase to 200 g. The threshold at which splenomegaly causes hypersplenism is also imprecise.

The classic definition of hypersplenism includes:
1) splenomegaly;
2) any combination of anemia, leukopenia and (or) thrombocytopenia;
3) compensatory bone marrow hyperplasia
4) “healing” after splenectomy.

At various diseases are developing various shapes hypersplenism, therefore, perhaps the definition of hypersplenism should be slightly modified, limiting it to cases where a pathologically altered spleen certainly causes more harm to the patient than good.

Bunty syndrome is an obsolete term and should be abandoned except in descriptions of historical interest. Sometimes this term is also used in relation to congestive splenomegaly in liver cirrhosis, as well as when there is blockage of the portal splenic vein.

The cause of splenomegaly can be very large number diseases, and at first glance it may seem that it is almost impossible to establish the cause of splenomegaly. However, often the enlargement of the spleen is a consequence of its fulfilling its normal function, i.e. working hypertrophy is observed.

The spleen performs a triple function in the body: firstly, it is the thinnest “filter” of the blood; secondly, it is the largest conglomerate of reticuloendothelial tissue, and thirdly, it is the largest lymph node in our body.

Performing a filtering function ( detailed description given in other manuals), the spleen, equipped a large number reticuloendothelial cells and lymphocytes, cleans the blood of microorganisms, antigenic particles, destroyed or pathological red blood cells, immune complexes, and is also a source of an early immune response, including the secretion of immunoglobulins and properdin factors.

Thus, the most common cause of splenomegaly is clinical practice is “working hypertrophy”, when the spleen intensively performs its normal filtering, phagocytic and immune function at acute infections, hemolytic anemia, diseases of immune complexes.

“Congestive” splenomegaly is just as common, since unique system microcirculation of the spleen, providing its filtering function, contributes to the enlargement of the spleen in response to increased pressure in the portal system.

The fourth function of the spleen includes embryonic hematopoiesis, which can be restored after the birth of a child, forming a focus of extramedullary hematopoiesis in some myeloproliferative diseases. Other causes of splenomegaly include tumors, infiltration, trauma, and developmental defects.

A detailed, although not exhaustive, list of causes of splenomegaly in adolescents and adults in the United States is given in Table. 149 they are grouped according to the pathogenetic mechanisms indicated above.

Table 149. Causes of splenomegaly

To date, only 46 cases of this disease have been described, and at least 20% of these patients subsequently developed lymphocytic leukemia. The following general pattern was also noted: the larger the size of the spleen, the narrower the circle possible reasons its increase.

Indeed, in the USA, giant splenomegaly (cases when the size of the spleen is 10 or more times higher than normal) is the first or one of the early symptoms The disease occurs mainly in myeloid metaplasia of unknown etiology, chronic myeloid leukemia, hairy cell leukemia, isolated splenic lymphoma, Gaucher disease, nontropical idiopathic splenomegaly, splenic cyst (usually epidermoid) and sarcoidosis.

The prevalence of splenomegaly can be roughly estimated by analyzing data from studies on the frequency of cases in which the spleen is palpable, although the palpable spleen is not always enlarged. In one study, nearly 3% of 2,200 healthy college freshmen had a palpable spleen that could not be explained by a history of illness. infectious mononucleosis or body constitution, they remained healthy during the 10-year follow-up.

According to another study, 2% of almost 6,000 adult outpatients examined continuously over the course of a year had a palpable spleen. In these studies, however, splenomegaly was not confirmed by radioziotope studies.

The first study noted a significant significant decrease in the frequency of detection of “palpable” spleens (from 3.7 to 1.4%) in the third year of the study when the doctors who examined the students changed, so the authors believe that the frequency of “palpable” may vary widely depending on quality of inspection and the ability of some eggs to relax abdominal wall and breathe deeply so that palpation of a normal spleen becomes possible.

Moreover, clinical methods are unreliable when detecting low-grade splenomegaly. According to one study conducted at a university hospital, the presence of splenomegaly, established radioisotope method, was confirmed by clinical examination in only 28% of cases, while medical error when detected, splenomegaly was found only in 1.4% of cases.

According to another study of the reliability of identifying the size of the spleen using clinical methods and radioisotope scanning, it was found that the doctor correctly diagnosed splenomegaly in 88% of patients using palpation and percussion simultaneously, but when using palpation alone, “overdiagnosis” was 10%, and when using percussion alone - somewhat more.

In general, we can fairly confidently assume that the true prevalence of splenomegaly in the outpatient population is approximately 1-2%.

Splenomegaly is any, even slight, increase in size of the spleen and is not an independent disease. This is a nonspecific condition characteristic of a variety of diseases.

The spleen is a parenchymal single organ in abdominal cavity, located in the left hypochondrium, is connected by ligaments to the diaphragm, colon, stomach and liver. Although she is not vital important body and you can live without it, it performs a number of important immune and non-immune functions.

Functions of the spleen

1. Creates a reserve (depot) of blood cells.
2. Controls the condition of blood cells and destroys old and damaged red blood cells.
3. It is where the final maturation of some fractions of lymphocytes and macrophages occurs.
4. Due to the presence of macrophages in the tissues of the spleen, it performs the functions of phagocytosis (capture and destruction of bacteria by macrophages).

The spleen is bean-shaped and its size depends on the age and height of the person. Normal sizes at the age of 1 year are 5-6 cm by 1.5 - 2.5 cm, by 5 years it measures 6-7 cm by 4.1 cm. In adolescence it increases to 8.5 -12 cm by 3 ,1 -4.8 cm. And in an adult, dimensions are considered normal: 9.1 - 12.1 cm by 3.5 by 5.1 cm. Some enlargement of the spleen in children, up to the youngest school age is not a pathology. Adults may also have minor splenomegaly due to various physiological reasons. Therefore, acceptable criteria for organ enlargement were established, so for a newborn it is 50% of normal sizes, for a 6-month-old baby it is 30%, and for junior school student and teenagers are only 3%. In an adult, on average, the spleen weighs 150–200 grams; a weight of more than 200 indicates splenomegaly.

With a condition such as splenomegaly, the causes in adults are exactly the same as in children. Often at the conclusion of the protocol ultrasound examination it can be seen that mild splenomegaly is present. What this is can be seen from the classification presented below.

According to the degree of enlargement of the spleen, there are :

• Moderate, in this case the maximum size in length is no more than 20 cm;
• Severe splenomegaly, more than 20 cm in length, can reach gigantic proportions.

Classification of splenomegaly

Due to their occurrence, there are two main forms:

Inflammatory splenomegaly

• Viral infections.

Infectious mononucleosis - more often than other viruses causes splenomegaly, the spleen is enlarged and dense on palpation.

Spicy viral hepatitis. First of all, the liver is affected, then the spleen, symptoms of general intoxication and jaundice are noted.

Splenomegaly can also occur with measles, rubella and cat scratch disease.

• Bacterial infections. With widespread bacterial infection or sepsis, the spleen may enlarge due to a pronounced immune response, and an abscess may also develop ( purulent inflammation) spleen.

Salmonellosis. Severe intoxication leads to the fact that the organ ceases to cope with its functions and increases in size.

Miliary tuberculosis with lesions internal organs. Leads to widespread lymphadenopathy, splenomegaly, and general intoxication.

Syphilis. Chronic launched form with damage to internal organs it also leads to an enlarged spleen.

• Defeat by protozoa.

Leishmaniasis, or rather its visceral form, which is characterized by damage to internal organs. With this disease, the spleen can reach very large sizes, such pronounced and adults, should always be tested for leishmaniasis.

Malaria - an enlarged spleen with this disease is especially common in young children and newborns with congenital malaria. Such children do not have clear temperature peaks characteristic of the disease and splenomegaly often becomes the only diagnostic criterion.

Toxoplasmosis. Splenomegaly occurs in cases of intrauterine infection of the fetus. In adults with acquired toxoplasmosis, an enlarged spleen is rare.

• Various fungal infections.

Histoplasmosis, common form. In Russia and the CIS countries it is quite rare, however, in the presence of splenomegaly, fever, liver enlargement and lymph nodes, it is necessary to do tests for histoplasmosis.

Blastomycosis. A severe fungal infection that affects the liver and spleen.

• Worm infestations, such as ascariasis, echinococcosis, trichinosis can also cause an enlarged spleen.

Non-inflammatory splenomegaly

• This condition is a sign large quantity diseases not associated with infections.
• Autoimmune diseases. These are diseases that arise due to a failure in immune system, as a result of which antibodies are produced against the body’s own cells (rheumatoid arthritis, systemic lupus erythematosus, Addison’s disease, periarteritis nodosa).
• Anemia in which red blood cells are destroyed. Congenital pathologies, such as spherocytosis, thalassemia, sickle cell anemia and other hemoglobin pathologies.
• Storage diseases can also lead to an increase in the size of the spleen. , histiocytosis, Gaucher disease.
• Splenomegaly can occur with diseases of the liver and circulatory system. Liver cirrhosis, chronic heart failure, portal or splenic vein thrombosis.
• Malignant diseases. Macroglobulinemia, lymphomas and some types of leukemia, tumor metastases.
• Other causes: splenic cyst, abscess, rupture.

Symptoms of splenomegaly

With minor and moderate splenomegaly, the symptoms of the underlying disease come to the fore, and an enlarged spleen will be a finding during examination. For anemia and thrombocytopenia this is:

• Fatigue, weakness, apathy;
• Pale skin, bruising;
• There may be weight loss;
• Tachycardia and heart murmurs;
• Sleep disorders;
• Decreased performance;
• Weakening of the immune system;

With viral and bacterial infections, first of all, general intoxication syndrome manifests itself (weakness, increased body temperature, headache) and symptoms characteristic of a specific infection.

With a pronounced increase, there will be symptoms associated with compression of the abdominal organs by the enlarged spleen. The signs of splenomegaly in an adult are practically no different from those in children.

• Pressing and aching pain in the left hypochondrium;
• Feeling of discomfort or foreign body in the left hypochondrium;
• Flatulence;
• Constipation;
• Decreased appetite, feeling of rapid satiety (associated with pressure on the stomach wall).

Diagnosis of splenomegaly

Primary diagnosis consists of examining the patient and palpating the spleen. With strong magnification, it can protrude through the anterior abdominal wall. By palpation (feeling), the doctor can quite easily determine whether the spleen is enlarged or not.

At the second stage of the examination, ultrasound of the abdominal cavity is used, which can reveal:

• concomitant enlargement of the liver (hepatolienal syndrome);
• possible cirrhosis of the liver, tumors, cysts and abscesses of the spleen;
• helminthic invasion of the liver (echinococcosis).

Abdominal MRI and CT (computed tomography) are also used.

Most often, the spleen enlarges compensatory when performing its tasks. normal functions, for example, removing microorganisms and antigens in the blood, destroying abnormal red blood cells (blood cells), but sometimes, the spleen enlarges in various diseases.

It is not possible to list all the diseases that are characterized by splenomegaly, but they can all be divided into main classes:

• autoimmune diseases;
• excessive death of red blood cells, for example, in hemolytic anemia, this can be explained by the abnormal structure of blood cells;
• congestion in the spleen, for example, thrombosis of the portal and splenic veins;
• some types of tumors, including blood.

Trauma, the formation of cysts, abscesses, and even the use of certain medications cannot be ruled out as causes of splenomegaly.

In pediatric practice, splenomegaly accompanies rickets; in infants, the organ becomes enlarged due to insufficient blood filling of the organ. For diseases such as typhoid fever, tuberculosis, birth defects heart, splenomegaly will be a typical and classic symptom.

Symptoms

Often, splenomegaly does not make itself felt, and no specific symptoms No. When an organ enlarges with various pathologies, the symptoms of the disease will be paramount, and splenomegaly is just a diagnostic criterion, a symptom that can be identified by a doctor during an examination.

The symptoms that arise due to an enlarged organ are nonspecific and are more often attributed to other pathologies or causes. Due to the fact that the organ is located close to the stomach, enlargement of the organ can cause constant feeling oversaturation, fullness of the stomach.

Sometimes you may notice pallor skin, sometimes so pronounced that the skin takes on a bluish tint. Symptoms may also be increased sweating at night, excessive fatigue, weight loss. Fever rarely occurs.

Diagnosis of splenomegaly in a child

The listed symptoms can be characteristic of many diseases, and most often they are attributed to the underlying pathology. Making a diagnosis requires collecting data - complaints, the child’s health status, what diseases have been suffered previously, whether blood diseases, autoimmune pathologies have been diagnosed.

Splenomegaly can be diagnosed only by palpation of the abdomen. Let us remind you that organ enlargement may not always indicate pathological reason maybe it's just defensive reaction body. Upon palpation, the doctor assesses the condition of the spleen - softness, density, pain when touched.

To make a diagnosis, depending on the suspected cause of splenomegaly, a number of laboratory tests, a general and biochemical blood test is required, general analysis urine and feces. Sometimes other specialists - hematologists, immunologists and even oncologists - are involved in the diagnostic process. As additional methods Studies may include ultrasound, CT and MRI.

Complications

The rapidly enlarging spleen begins to actively process red blood cells, which ultimately can cause the development of anemia. In addition, excessive processing of platelets and white blood cells in organs can make the child more susceptible to infections.

Treatment

What can you do

Due to the fact that splenomegaly is not a disease, but only a symptom, treatment will only be required for the underlying pathology. Main task parents to recognize the onset of the disease in time and monitor the child’s condition. Sometimes increased fatigue, moodiness and poor appetite will be the only symptom of the pathology, and if it is accompanied by an enlarged spleen, in most cases it is quite serious.

What does a doctor do

All treatment is based on the diagnosis and the underlying cause. If these are infectious pathologies, treatment often takes place in a hospital with a strict list of recommendations and treatment. In case of blood diseases, a long-term study of the child is required and a treatment plan is drawn up, so hospital treatment may be needed more than once.

Symptomatic treatment, i.e. measures that will return the organ to its normal size are not required, and do not make sense, since if the underlying cause is untreated, the spleen will increase again and again. Upon recovery, the size of the organ will return to normal.

Only in rare cases, according to strict indications, is it indicated surgical treatment- removal of the spleen.

Prevention

Preventive measures in case of splenomegaly, they are reduced to the prevention of the underlying pathology. In case infectious diseases- compliance with basic hygiene rules, avoiding foci of infection, strengthening the body's defenses. It is also necessary to promptly and fully treat all pathologies of internal organs.

Stick to it healthy image life, follow the rules of healthy and proper nutrition, if necessary, after consultation with a specialist, take preventive courses of multivitamins.

And caring parents will find on the service pages complete information about the symptoms of splenomegaly in children. How do the signs of the disease in children aged 1, 2 and 3 differ from the manifestations of the disease in children aged 4, 5, 6 and 7? What is the best way to treat splenomegaly in children?

Take care of the health of your loved ones and stay in good shape!