Splenomegaly - what it is, causes, symptoms, treatment and proper nutrition for adults. Insidious diagnosis: splenomegaly Splenomegaly treatment with medications

The spleen has a very great importance for the human body. In children, during intrauterine development, it is involved in the process of hematopoiesis. In adults, it fights pathogens and builds immunity. It is a repository for iron, which is so necessary for the creation of hemoglobin. Blood accumulates in it, which, if there is a sharp shortage, will immediately go into the bloodstream. But under the influence of some negative factors and diseases, the spleen can pathologically increase in size and reach gigantic sizes, filling more than half abdominal cavity. This condition is called splenomegaly and can lead to rupture of this unpaired organ, complications concomitant diseases and to a decrease in blood cells with the subsequent development of anemia, leukopenia or thrombocytopenia.

Causes of splenomegaly and main symptoms

Splenomegaly is not an independent disease; an enlarged spleen occurs against the background of other diseases. The reasons that provoke pathological enlargement of the spleen are described below.

Chronic bacterial infections:

• Splenic tuberculosis – left-sided moderate abdominal pain, fever up to 40˚C, nausea.
• Brucellosis – the same symptoms with the addition of diarrhea.
• Syphilis - damage to lymph nodes and others internal organs, temperature up to 41˚C.

Acute bacterial infections:

• Typhoid diseases - severe abdominal pain and diarrhea, heat bodies.
• Miliary tuberculosis – damage to internal organs with an increase in temperature up to 42˚C.
• Sepsis.

Acute and chronic bacterial infections are very common reasons splenomegaly.

The reasons why splenomegaly occurs may be hidden in liver disease. These are liver cirrhosis, cystic fibrosis, portal hypertension ( high blood pressure in the portal vein), biliary atresia (obstruction or absence). Very often, an enlargement of the spleen occurs against the background of the appearance malignant neoplasms in organism.

Splenomegaly is a natural symptom in children with portal hypertension. In children, symptoms in this case manifest themselves in an increase in abdominal volume and flatulence, an increased pattern of the venous vessels of the peritoneum, and sometimes ascites (accumulation of free fluid).

Specific symptoms of splenomegaly are frequent hiccups, abdominal pain (above left), and the body's inability to take in large amounts of food.

Diagnosis of splenomegaly

A patient comes to the doctor with complaints of pain in the left hypochondrium, nausea and unstable loose stool accompanied by elevated body temperature.

After visual inspection The patient's doctor palpates the painful area on the abdomen and detects an enlarged spleen. To find out the reasons for this pathological condition, the therapist asks several questions about events in the patient’s life that could lead to this: whether there have been any trips to exotic countries what was eaten, etc. An anamnesis of the disease and a family history are collected (the presence of diseases of the blood, gastrointestinal tract, spleen and liver in relatives is determined).

To find out the causes of the disease splenomegaly and prescribe correct treatment, a number of laboratory tests are done:

• A clinical blood test that will reveal possible anemia. Increased content leukocytes in the blood will indicate an inflammatory process occurring in the body.
• Blood test for biochemistry. It makes it possible to evaluate the functioning of the pancreas and liver, as well as determine the amount of important microelements.
• General urine analysis (condition of the genitourinary system).
• Stool analysis (assessment of the digestive system).
• Analysis of stool for worm eggs.
• Coagulogram (blood clotting test).
• Blood culture to determine the causative agent of infection in the body.

Additional studies to determine the cause of splenomegaly are based on instrumental methods:

• Ultrasound of the abdominal cavity to check all its organs. The examination confirms an abnormally enlarged spleen. In newborns, the normal length of the spleen is 40 mm, in children 3-7 years old - 80 mm, in an adult - 120 mm with a weight of approximately 160 g. With splenomegaly, these figures are greatly exceeded.
• CT ( CT scan) abdominal organs for a more thorough examination or detection of possible malignant tumors.
• Genetic studies to identify hereditary diseases, causing disease splenomegaly.
• Autoimmune biochemical markers (immune system check).
• Sternal puncture (puncture of the sternum to remove bone marrow for examination and determination of tumors of hematopoietic tissues).

Consultation with a hematologist can help determine the causes of the disease.

Treatment of an enlarged spleen

In order for the treatment of the disease to be successful, splenomegaly must be correctly and accurately diagnosed for all possible causes of development.

Treatment is carried out using antibacterial drugs(if splenomegaly has a bacterial etiology). Treatment of tumors and diseases of the hematopoietic system consists of the use of antitumor drugs. Widely used hormonal drugs and vitamin therapy.

If conservative treatment does not bring results, surgical treatment (removal of the spleen) is prescribed.

There are no measures to prevent the development of this pathology, but a person can prevent the diseases that provoke it - do not smoke, do not abuse alcohol, do all vaccinations before traveling, routine vaccinations. A person with a spleen disorder called splenomegaly should avoid sports to prevent it from rupturing.

Splenomegaly is a pathology and not an independent disease. This pathology is manifested by a change in the size of the spleen. It may indicate the presence of various diseases and health problems. Therefore, if the spleen is enlarged, it is necessary to consult a doctor and find out the reason that triggered it.

Often splenomegaly manifests itself with an increase in lymph nodes. Lymph nodes may become enlarged due to increased destruction cancer cells, due to infectious inflammation, as well as due to cancer diseases. It is not difficult to determine that the spleen is enlarged. This can be done by ordinary palpation. If the doctor determines that this organ is enlarged in size, he may prescribe additional examination and prescribe a tomography or radionuclide scan.

Causes of enlarged spleen

Unfortunately, an enlarged spleen does not mean anything good. Very often the reason for the enlargement of this organ is the presence serious illnesses. If the spleen is too enlarged in size, this may be due to chronic myeloid leukemia, lymphocytic leukemia, myelofibrosis, non-Hodgin lymphoma, polycythemia and other diseases. In addition, the spleen may become enlarged due to advanced cirrhosis. Signs of cirrhosis are swelling of the legs, jaundice, accumulation of fluid in the abdominal cavity, and enlarged liver. Patients with this disease develop hepatic encephalopathy, which is manifested by a decreased level of consciousness and slurred speech.

The appearance of congestive splenomegaly can cause thrombosis of the splenic vein or certain disorders of vascular development. In addition, the spleen may become enlarged in severe forms of brucellase. This disease is rare but dangerous. The first symptoms of brucellase are weakness, headache, sweating, nausea, lower back pain, elevated temperature. In the later stages of the disease, the liver and spleen increase in size.

Various inflammatory and infectious diseases can cause an enlarged spleen. Most often this is caused by acute infections. For example, amyloidosis, infective endocarditis and the like. The accumulation of abnormal amyloid protein in the spleen can also cause it to enlarge. However, the symptoms of the disease can manifest themselves in different ways. Sometimes doctors diagnose kidney failure, which manifests itself as a lack of urine. Heart failure may manifest itself in the form of shortness of breath and. Even problems with the gastrointestinal tract can cause an enlarged spleen.

Chronic infections sometimes cause an enlarged spleen. Also, connective tissue diseases and sarcoidosis can lead to the development of this pathology. In patients with endocarditis, the spleen often enlarges in the second or third week. In this case, the patient also experiences other symptoms characteristic of the disease.

Rheumatoid arthritis entails a lot of symptoms, including an enlarged spleen. Splenomegaly can be caused by malaria. But an enlarged spleen in this case will be detected before the onset of fever.

Lipid and non-lipid diseases can lead to the development of pathology. In particular, this is a disorder of protein metabolism, Letterer-Sieve disease, Hand-Schüller-Christcher disease, a disorder of protein metabolism. This pathology is most often provoked by a splenic cyst, which occurs due to the destruction of a previous hematoma. On early stages Chronic or acute leukemia may also enlarge the spleen.

Patients with viral hepatitis are faced with such pathology as splenomegaly. With this disease, not only the spleen, but also the liver enlarges, and jaundice, nausea, fever, vomiting, weakness, and fever also appear.

Very rarely, an enlarged spleen is caused by a rare fungal infection such as histoplasmosis. In this case, most often the spleen increases in size with disseminated histoplasmosis. In addition to this symptom, patients also have other symptoms: swollen lymph nodes, exhaustion, weakness, fever, anemia. In rare cases, patients' larynx, tongue and palate become covered with ulcers, which leads to painful swallowing and hoarseness of the voice.

Symptoms of splenomegaly

Symptoms of splenomegaly will begin to appear only when the spleen is greatly enlarged in size. Symptoms will be associated with stretching of the spleen capsule and compression of the surrounding organs. Because of this, the patient will be bothered by bloating, constipation, and aching pain in the left hypochondrium. If you put pressure on a patient’s stomach, he will have a feeling of fullness in his stomach and will immediately lose his appetite. In addition, the person will be bothered by heartburn.

This is not the entire list of symptoms of splenomegaly. After all, as mentioned above, splenomegaly is not separate disease, but only one of the symptoms of the disease. Therefore, a person who has this pathology will experience other symptoms of the disease, which caused the enlargement of the spleen.

Diagnosis of splenomegaly

Before diagnosing the disease, the doctor carefully listens to all the patient’s complaints. Then the doctor will try to understand what disease could trigger the development of splenomegaly. The doctor may ask how long ago the symptoms began, what caused them, etc. You must also inform your doctor if you have visited exotic countries. Everyone needs to be mentioned bad habits(smoking, drinking alcohol), about diet.

It is very important for the doctor to know whether the patient’s relatives had diseases of the spleen, blood, gastrointestinal tract or liver. After all this information, the doctor palpates the spleen to determine how much it has increased in size. Thanks to palpation, the doctor will be able to understand what the density of the splenic tissue is and how painful pressure is on it. Then the doctor will recommend the patient to undergo additional examinations. The following tests are prescribed: biochemical analysis blood and clinical analysis, coprogram, general analysis urine, coagulogram, stool test for worm eggs, blood test to identify the pathogen. Abdominal ultrasound, sternal puncture, computed tomography, genetic studies, and autoimmune biochemical markers may also be prescribed.

Treatment of splenomegaly

Treatment of this pathology is always complex. After all, it is aimed not only at eliminating the main symptom (enlarged spleen), but also at treating the disease that led to splenomegaly. In particular severe cases enlarged spleen removed surgically. Surgery indicated for thalassemia, Gaucher disease and hairy cell leukemia. After removal of the spleen, the patient's susceptibility to meningococcus, Haemophilus influenzae and pneumococcus increases. That is why, before removal, the patient receives appropriate vaccinations to reduce the risk of negative consequences.

Prevention of splenomegaly

Since splenomegaly is not an independent disease, there are no specific preventive measures against it. But doctors recommend giving up bad habits, as they very often provoke an enlarged spleen. Before traveling to exotic countries, you must have all vaccinations. Moderation will also be beneficial. exercise stress. It is equally important to undergo routine examinations with doctors.

Splenomegaly, i.e. significant enlargement of the spleen, can be of a wide variety of origins. There are many reasons for this pathology and possible ways their classifications.

Symptoms and signs of splenomegaly

Clinical features, course of the disease and laboratory data often make it possible to recognize the main forms of splenomegaly.

Tumor abdominis, located mainly in the upper left quadrant, is recognized precisely as an enlarged spleen, and not any other organ:

1. along the characteristic anterior edge with notches - margo crenatus, incisurae lienales;
2. by superficial location, easy accessibility to palpation over a long distance, significant spread of dullness upward, towards the chest; when the colon is inflated with air, the spleen is not pushed away from the abdominal wall;
3. by the frequent presence of simultaneous enlargement of the liver, lymph nodes and blood changes (leukopenia, anemia);
4. by rapid and distinct contraction of the spleen after subcutaneous injection adrenaline.

It should be remembered that the size of the spleen may change depending on the mental state of the patient, the phase of digestion, and changes in endocrine influences(the spleen shrinks during pregnancy); finally, strong percussion in the area of ​​the spleen reduces its size. All these data on neuroreflex changes in the size of the spleen were already established by Botkin and are of great scientific and practical importance.
Bykov proved the influence of various external stimuli on the spleen in the order of conditioned reflexes.

The size of an enlarged spleen in the clinic is determined mainly by its length - from the upper edge of the bluntness along the axillary line to the lower anterior pole of the spleen, determined by palpation (if the spleen is not palpable, its lower border is determined by percussion). Percussion can also easily delimit the anterior edge of splenic dullness. The posterior border of the spleen is not clearly defined by percussion (Obraztsov).

X-ray is able to recognize the spleen, its contours, location, enhancing the contrast by inflating the large intestine with air or more complex method pneumoperitoneum, as well as injecting Thorotrast into the blood, as in liver studies. To differentiate from an enlarged left kidney, in doubtful cases, cystoscopy, pyelography, and pneumorenus are performed. Examine urine in normal conditions and after palpation of the tumor: if the tumor belongs to the kidney, provoked hematuria may appear.

The following diseases are especially often accompanied by splenomegaly.

Causes of splenomegaly

The spleen can enlarge as a result of pathological lymphoproliferation, the appearance of foci of extramarrow hematopoiesis in it in myeloproliferative diseases, and increased activity of the reticuloendothelial system in autoimmune hemolysis. Sharp severe splenomegaly observed in chronic myeloid leukemia, subleukemic myelosis, malaria and leishmaniasis. Hepatosplenomegaly is more characteristic of lympho- or myeloproliferative diseases, lesions of the liver itself, or storage diseases, such as amyloidosis. Splenomegaly with simultaneous enlargement of the lymph nodes makes the diagnosis of lymphoproliferative disease even more likely. An enlarged spleen can cause abdominal discomfort, back pain, and a feeling of fullness due to pressure on the stomach. It is possible that splenic infarctions may develop, which are accompanied by severe abdominal pain radiating to the left shoulder. At the same time, a friction rub of the spleen is detected during auscultation. Sometimes spontaneous or trauma-related organ ruptures occur.

Diagnosis of splenomegaly

The diagnostic search is aimed at identifying the most probable cause splenomegaly. Ultrasound and CT scans evaluate the density of spleen tissue and identify changes characteristic of lymphoproliferative diseases. At the same time, the liver or abdominal lymph nodes are imaged. The diagnosis is confirmed by a biopsy of lymph nodes, including abdominal ones. Involvement of the mediastinal lymph nodes in the process is determined radiographically. IN clinical analysis blood, pancytopenia can be detected as a secondary manifestation of the disease. In case of pathology in the smear (altered lymphocytes, young forms of leukocyte or erythroblastic sprout), a bone marrow examination is indicated. Screening for infection and liver disease may be necessary. If none of the data obtained leads to a final conclusion, in order to make an accurate diagnosis, they resort to removing the spleen.

Anamnesis. Most existing symptoms are the result of an underlying disease. However, splenomegaly itself can cause early satiety due to pressure from the enlarged spleen on the stomach. Severe pain may be a sign of splenic infarction.

Physical examination. The sensitivity of palpation and percussion in detecting an increase in the size of the spleen (according to ultrasound data) is 60-70% and 60-80%, respectively. In thin people, the spleen can be palpated in 3% of cases.

May be observed additional symptoms: friction noise of the spleen against the parietal peritoneum, which indicates the presence of splenic infarction, epigastric and splenic sounds characteristic of congestive splenomegaly.

Diagnostics. If the physical examination is equivocal, instrumental confirmation of splenomegaly may be required. In this case, the method of choice is ultrasound due to its accuracy and low cost. CT and MRI allow more detailed visualization of the spleen. Scintigraphy is highly accurate, which allows you to identify the presence of accessory elements of the spleen, but this method is expensive and difficult to perform.

Specific causes of splenomegaly suspected during the clinical examination should be confirmed by appropriate diagnostic methods(see relevant sections of the manual). If there is no suspected cause, it is first necessary to exclude hidden infections, since early initiation of treatment affects the outcome infectious disease to a greater extent than on the outcome of other diseases associated with splenomegaly. In areas of wide geographical distribution infection or if the patient has signs of disease, the examination should be carried out especially carefully. If Clinical signs diseases (other than symptoms directly related to splenomegaly) and risk factors for infection are absent, recommendations regarding the range of tests performed are controversial.

Specific changes in peripheral blood tests may indicate an underlying disease (small lymphocytes in chronic lymphocytic leukemia, large granular lymphocytes in T-cell granular lymphocytic hyperplasia (TGL) or T-cell leukemia; leukocytosis with a predominance of immature forms in other leukemias). An increased number of basophils and eosinphils, red blood cells containing nuclei or having the shape of a “falling drop” indicate myeloproliferative diseases. Cytopenic syndrome is a sign of hypersplenism. Spherocytosis is observed with hypersplenism or hereditary spherocytosis. In liver cirrhosis with congestive splenomegaly, multiple abnormalities in liver function tests are observed. An isolated rise in serum alkaline phosphatase is characteristic of infiltration of liver tissue in myeloproliferative, lymphoproliferative diseases and miliary tuberculosis.

Diffuse hypergammaglobulinemia indicates the presence chronic infection(malaria, kalaazar, brucellosis, tuberculosis), liver cirrhosis with congestive splenomegaly, sarcoidosis or connective tissue diseases. Raising serum levels uric acid characteristic of lymphoproliferative or myeloproliferative disease. An increase in the level of leukocyte alkaline phosphatase is observed in myeloproliferative diseases.

If the examination did not reveal any abnormalities other than splenomegaly, a repeat examination is carried out in the interval from 6 to 12 months.

Types of splenomegaly

Chronic myeloid leukemia- a form that is easily recognized by the simultaneous enlargement of the liver and lymph nodes, painful bones and by a basic blood test, even without a microscope. With a large number of leukocytes, blood mixed with 5 parts of distilled water does not become lacquered, but remains cloudy from suspension large number leukocytes; In a test tube, settled citrated blood gives a clear, creamy layer of leukocytes.

Thrombophlebitic splenomegaly(splenomegalia splenothrombo-tica) is the most common form of long-term, sometimes decades-long, isolated (solitary) splenomegaly in the absence of any other manifestations of the disease. Later, pallor, weakness, periodic fever with pain in the spleen, leukocytosis, bloody vomiting from varicose veins of the esophagus and stomach (collateral circulation occurs through the vasa brevia of the stomach), ascites.

Ascites can be recurrent in nature, appearing mainly after esophageal bleeding, which also causes contraction of the spleen. Anatomically, the spleen exhibits significant plethora (“congestive splenomegaly”), sometimes partial fibrous degeneration.

Etiology thrombophlebitic splenomegaly - abdominal trauma, chronioseptic and specific general infections (syphilis, malaria and their consequences), acute and chronic phlebitis of unknown etiology, damage to the tumor and inflammatory nature of neighboring organs - pancreas, kidneys - leading to thrombosis of adjacent venous trunks.

Treatment. General hygienic gentle regimen, periodic bed rest, antibacterial agents. During an exacerbation - carefully leeches and medicines, preventing blood clotting. IN early periods splenectomy. To more reliably reduce portal hypertension (especially in cases of more common thrombosis in the portal vein system), it is proposed to sew the splenic vein into the left renal vein or apply other types of anastomoses between the portal and inferior vena cava.

Splenomegalic cirrhosis of the liver atrophic or hypertrophic type is easily diagnosed by the presence of an altered liver, collateral circulation, ascites or jaundice, a positive fuchsino-sublimate test and other functional liver tests, etc.

The early stages of splenomegalic cirrhosis of the liver can only present a picture of splenic anemia and leukopenia in the presence of fibrosis (fibroadenia) of the spleen, and liver function does not suffer any significantly.

Splenectomy during this period can slightly improve blood composition and general state sick. The so-called Banti syndrome represents a pathophysiological pattern of development of cirrhosis of the liver, due to primary damage to the spleen, leading primarily to splenic anemia and leukopenia, alleviated at this stage by splenectomy. It should be remembered that almost always with Banti syndrome there is cirrhosis of the liver, unless infections such as malaria are visible, visceral leishmaniasis, brucellosis, syphilitic or septic splenomegaly, therefore the diagnosis of Banti syndrome, or disease, should not be made.

Hemolytic jaundice easily recognized by the presence of perennial mild jaundice, according to some common features and characteristic changes in blood.

Lymphogranulomatosis occurs with enlarged lymph nodes, fever, itching, etc. (see below).

Chronic lymphatic leukemia, erythremia, Worlhof's disease, malignant anemia and other blood diseases that occur with an enlarged spleen are recognized by the corresponding general and hematological signs.

Quite often, splenomegaly is caused by infections with a protracted course, such as: malaria, brucellosis, visceral leishmaniasis, subacute septic endocarditis, meningococcal sepsis, syphilis, from acute infections - relapsing fever, leptospirosis, etc.

Splenic infarction, usually already increased earlier with acute infections(subacute septic endocarditis), leukemia, thrombophlebitic splenomegaly, etc., characterized by sudden acute pain in the spleen, septic fever, chills, enlargement and soreness of the spleen; With the development of perisplenitis, the pain lasts for a long time, and a peritoneal friction noise is heard. The cause of a heart attack is embolism from the heart and other organs (in terms of frequency of localization, splenic embolism is in second place after the kidneys) or local vascular thrombosis.

Rupture of the spleen in acute malaria, relapsing fever, abdominal trauma gives a picture acute pain, collapse, internal hemorrhage with accumulation of blood in the abdominal cavity and is of predominantly surgical interest, requiring urgent splenectomy.

You should also remember about enlarged spleen with nutmeg (cardiac) cirrhosis of the liver, pericardial pseudocirrhosis of Picca, general amyloidosis, with isolated tuberculosis of the spleen, hydatid cyst of the spleen and a number of others rare diseases spleen.

These include systemic lipoidoses: Gaucher disease, when the spleen enlarges, along with the liver, due to the deposition of cerebrosides in characteristic large cells, with the nucleus pushed to the edge, easily detected in bone marrow punctate; The disease has a chronic, multi-year course, starting in childhood, occurs with anemia, brown pigmentation of the skin, yellowish infiltrates in the conjunctiva; Niemann-Pikka disease, which affects children and quickly leads to death due to the phenomena of splenohepatomegaly, anemia, leukocytosis, brown pigmentation of the skin; Hand-Christian-Schüller disease and also a disease of childhood with xanthomatosis of the skin and bones, leading to round defects of the skull, hips, pelvis, vertebrae, with exophthalmos, dwarfism, diabetes insipidus.

Treatment of splenomegaly

Treatment directly depends on the underlying disease. An enlarged spleen itself does not require treatment, except in cases of severe hypersplenism.

The spleen is a fist-sized organ located on the left under chest. Because of various diseases it may increase in size, a phenomenon called splenomegaly. What it is, how to treat this disorder - we talk about this in detail in this publication.

Splenomegaly - what is it?

Splenomegaly is an enlargement of the spleen. Pathology can be caused by many reasons and occurs in both adults and children. The spleen plays important role in the fight against infections. Leukocytes are formed in it, which are the first to begin destroying pathogens that have entered the body.

Other functions of the spleen:

1. Filtration and destruction of damaged and old blood cells;
2. Production of a reserve amount of red blood cells, which are used by the body when necessary, for example, during blood loss;
3. Protein synthesis;
4. Storage of a supply of blood cells (platelets, erythrocytes, leukocytes);
5. Destruction of insoluble compounds resulting from burns.

Splenomegaly is considered as a symptom of a particular disease and is accompanied by a violation of each of these important processes. For example, the spleen begins to filter out not only damaged, but also normal blood cells, which, accumulating in it, interfere with proper operation organ.

Causes of splenomegaly

There are many diseases that cause splenomegaly. This phenomenon may be temporary, depending on the effectiveness of treatment of the underlying disease. In addition to pathologies of the spleen - tumors, cysts, organ infarctions, abscesses - with splenomegaly the causes may be as follows:

• acute and chronic bacterial infections - brucellosis;
• viral pathologies – hepatitis, rubella, measles;
• mycoses - blastomycosis, histoplasmosis and other fungal infections of the blood and internal organs;
• protozoal infections – leishmaniasis, ;
• helminthiases – schistosomiasis;
• circulatory disorders - development, Pick's cirrhosis;
• systemic diseases of the hematopoietic organs - leukemia, lymphoma, myelofibrosis;
• pathologies associated with metabolic disorders - glycogenosis, Wilson's disease;
• autoimmune diseases, in which the immune system mistakes body cells for foreign ones – rheumatoid arthritis, systemic lupus erythematosus.

Anemia is also a cause of splenomegaly. different types– pernicious, hemolytic and others.

Splenomegaly in children

In childhood, the spleen is sometimes slightly enlarged without any disturbances in the child’s body. This is physiological norm and is observed in a third of newborns, in 15% of six-month-old children and in a small part of primary schoolchildren.

The norms for the maximum size of the spleen in children are presented in the table:

Splenomegaly in children is a symptom of the same diseases as in adults; there are no differences.

There are two forms of splenomegaly:

1. Inflammatory, which occurs when organ tissues become inflamed (bacterial, protozoal, viral infections, helminthic infestations, abscesses and heart attack);
2. Non-inflammatory, caused by disorders not associated with infections and inflammation (with anemia, systemic, autoimmune diseases).

Moderate splenomegaly is also distinguished when the length of the spleen does not exceed 20 cm, and severe - 21 cm or more.

pain on the left under the ribs - one of the symptoms, photo

Since an enlarged spleen is a manifestation of a particular disease, common symptoms she does not have. There are only signs of splenomegaly associated with its two forms.

1 - manifestations of inflammation:

• high temperature, up to 40°C;
• sharp cutting pain in the left hypochondrium;
• mild nausea;
• sometimes vomiting and diarrhea;
• palpable pain on palpation of the left side under the ribs.

2 - symptoms of splenomegaly without inflammation:

• pulling, aching, unexpressed;
• body temperature remains normal, and if it increases, then to a maximum of 37.5 °C;
• When palpating the side, the pain is not severe.

Diagnosis of splenomegaly

The primary diagnosis of splenomegaly is carried out by palpation of the abdomen in the left hypochondrium. To clarify the diagnosis, the following studies are indicated:

• General clinical blood test to determine the number of leukocytes, red blood cells and platelets;
• Taking liver samples;
• and computed tomography;
• ultrasound examination;
• Bone marrow biopsy, which provides more complete information about the state of blood cells.

A puncture biopsy of the spleen is performed extremely rarely, as it carries a risk of bleeding.

Treatment tactics for splenomegaly

Therapy for splenomegaly in adults and children consists of identifying and eliminating the pathology that provoked the enlargement of this organ. Depending on the specific disease, the following drugs are prescribed:

Surgical removal of an enlarged spleen (splenectomy) is indicated if conservative treatment of splenomegaly is unsuccessful.

Surgery also necessary for:

• hypersplenism, when healthy cells blood is destroyed in the spleen;
• thrombocytopenic purpura;
• Banti syndrome;
• hemolytic jaundice.

The operation is often performed through laparoscopy - through small incisions. As a result of the removal of the spleen, the body's ability to resist infections is reduced. In this regard, antibiotics are necessary before and after splenectomy. Vaccinations are also carried out against meningitis, Haemophilus influenzae, pneumococcal infections and influenza.

Complications

TO possible complications splenomegaly includes:

• Hypersplenism is a lack of formed elements in the blood due to their breakdown in the spleen (leukopenia, anemia, thrombocytopenia);
• Organ rupture;
• Worsening of the pathology, against the background of which the spleen was enlarged.

Splenomegaly - which doctor should I contact?

Since the spleen is a hematopoietic organ, its pathologies are treated by a hematologist. But since pain in the left side under the ribs and other manifestations of splenomegaly can be the result of various diseases, you should first make an appointment with a therapist, describing in detail all the symptoms.

After examining and studying the results of basic tests, he will refer you to a more specialized specialist for further diagnosis and treatment.

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 the abdominal cavity, located in the left hypochondrium, 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, it happens :

• 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 damage to 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 more precisely 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, enlargement of the liver 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 be associated with liver disease 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, a general intoxication syndrome manifests itself (weakness, fever, 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 front 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.