Splenomegaly: disease or symptom? Splenomegaly - what is it? Causes and treatment, signs of splenomegaly Moderately pronounced splenomegaly.

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Definition and reasons

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

The normal mass 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 inaccurate.

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

Different diseases develop different forms of hypersplenism, therefore, perhaps, the definition of hypersplenism should be somewhat changed, limiting it to cases where the pathologically altered spleen certainly does more harm than good to the patient.

Bunty's 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 cirrhosis of the liver, as well as blockage of the portal sludge of the splenic vein.

The cause of splenomegaly can be a very large number of 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 the performance of 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 (a detailed description is given in other manuals), the spleen, supplied with a large number of reticuloendothelial cells and lymphocytes, cleanses the blood of microorganisms, antigenic particles, destroyed or pathological erythrocytes, 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 in clinical practice is "working hypertrophy", when the spleen performs its normal filtering, phagocytic and immune functions intensively in acute infections, hemolytic anemia, and immune complex diseases.

Congestive splenomegaly is also common, as the unique microcirculation system 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 is 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 1. 149 they are grouped according to the above pathogenic mechanisms.

Table 149. Causes of splenomegaly

So far, 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 range of possible reasons for its enlargement.

Indeed, in the United States, giant splenomegaly (cases where the size of the spleen is 10 or more times higher than normal) as the first or one of the early symptoms of the disease occurs mainly in myeloid metaplasia of unknown etiology, chronic myeloid leukemia, "hairy cell" leukemia, isolated lymphoma of the spleen , Gaucher disease, nontropical idiopathic splenomegaly, spleen 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 infectious mononucleosis or body constitution, and remained healthy during a 10-year follow-up.

In another study, palpable spleens were found in 2% of nearly 6,000 adult outpatients examined throughout the year by a continuous method. In these studies, however, splenomegaly was not confirmed by radiosiotope studies.

In the first study, there was 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 changing doctors who examined students, so the authors believe that the frequency of "palpable" can vary widely depending on quality of inspection and the ability of some eggs to relax the 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 by radioisotope method, was confirmed during clinical examination in only 28% of cases, while medical error in detecting splenomegaly occurred in only 1.4% of cases.

According to another study of the reliability of detecting 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 one palpation, "overdiagnosis" was 10%, and when using one percussion - a few more.

In general, the true prevalence of splenomegaly in the outpatient population can be taken with some confidence to be approximately 1-2%.

Splenomegaly (from Greek splen "spleen", megas "large") is a term for an enlarged spleen. Splenomegaly is usually spoken of when the mass of this organ is more than 600 g. At the same time, it can be felt in the left half of the abdomen in the hypochondrium.
The reasons for the enlargement of the spleen in size are diverse, since this organ performs many different functions in the body. Therefore, the causes of splenomegaly are usually classified according to the mechanisms of their development.

The following main types of splenomegaly are distinguished:

"working" hypertrophy in response to the systemic action of toxins associated with the immune response to infection;
hypertrophy associated with increased breakdown of blood cells in the spleen;
enlargement of the spleen associated with stagnation of venous blood in it;
increased formation of pathological blood cells in tumors of the blood and bone marrow;
splenomegaly of mixed origin.

The reasons

On the left, the spleen is of normal size; on the right, it is enlarged.

Enlargement of the spleen in infectious and toxic processes

When antigens enter the body from the external environment or under the influence of internal toxic factors, an intensive immune process develops. The spleen actively participates in it, while its blood supply and the mass of cells contained in it increase.
Enlargement of the spleen is characteristic of many inflammatory, necrotic processes in the body. It occurs in acute infections (infectious mononucleosis, hepatitis, typhus, tularemia, sepsis, infective endocarditis). Splenomegaly is characteristic of chronic infections such as tuberculosis, malaria. It occurs with toxoplasmosis,.

Enlargement of the spleen with increased breakdown of blood cells

In the spleen, a physiological process of destruction of obsolete blood cells (erythrocytes, platelets, leukocytes) takes place. In diseases of the blood, accompanied by an increased destruction of these formed elements, there is a natural increase in the size of the spleen.
This mechanism of splenomegaly is characteristic of a number of anemias accompanied by the breakdown of red blood cells (the so-called hemolytic anemias). These include congenital spherocytosis, autoimmune hemolytic anemia, sickle cell anemia.
Autoimmune diseases with the destruction of white blood cells (neutropenia) and platelets () can also sometimes be accompanied by an enlarged spleen.
In chronic hemodialysis, the instability of blood cell membranes develops, they are easily destroyed. Therefore, with hemodialysis, the development of splenomegaly is also possible.

Stagnation of venous blood in the spleen

The venous network is well developed in the spleen. Therefore, if the outflow of venous blood from it is disturbed, it increases. With the accumulation of blood in this organ, the growth of vascular tissue begins, the number of red blood cells increases. The so-called Bunty's disease develops.
Stagnation of blood in the spleen can occur during various processes leading to an increase in pressure in the system of the portal, splenic, hepatic veins. These large veins can be compressed, for example, by a tumor in the abdominal cavity. Their lumen may be blocked by a thrombus. Cirrhosis of the liver leads to an increase in venous pressure. Severe cases with severe edema are also accompanied by stagnation of blood in the spleen and its enlargement.

Enlargement of the spleen in blood diseases

In the embryonic period, the spleen is a hematopoietic organ. Therefore, in blood diseases, new foci of hematopoiesis and metastases can appear in it. Sometimes there are primary tumors of the spleen.
Splenomegaly is accompanied by such serious diseases as subleukemic myelosis, chronic myeloid leukemia, chronic lymphocytic leukemia, lymphogranulomatosis, lymphoblastic leukemia, multiple myeloma, polycythemia vera, essential thrombocythemia, etc.

Enlargement of the spleen of mixed origin

Symptoms of splenomegaly

Splenomegaly may be accompanied by pain in the left hypochondrium, bloating, and a tendency to constipation.

Symptoms of an enlarged spleen occur when it is of considerable size and is associated with stretching of its capsule and compression of surrounding organs. Therefore, signs of an enlarged spleen can be aching pain in the left hypochondrium, constipation, and bloating. With compression of the stomach, there is a feeling of early satiety and lack of appetite, as well as signs of reflux of the contents of the stomach into the esophagus ().
An enlarged spleen is accompanied by signs of the disease that caused it. It can be weakness, sweating, fever, bleeding, weight loss, etc.

Treatment of splenomegaly

Treatment of splenomegaly is aimed at treating the underlying disease (treatment of the infectious and inflammatory process, lowering pressure in the veins of the abdominal cavity, chemotherapy for tumors, etc.).
Sometimes surgical removal of an enlarged spleen is indicated (), for example, in idiopathic thrombocytopenic purpura. In this disease, the removal of the spleen leads to a rapid restoration of the level of platelets in the blood.
Splenectomy is also performed for Gaucher disease, hairy cell leukemia, thalassemia.
After such an operation, a person's susceptibility to pneumococcus, meningococcus and Haemophilus influenzae increases, therefore, such patients are vaccinated against the corresponding microorganisms.

Which doctor to contact

If heaviness appears in the left hypochondrium, you should consult a therapist who will find out the primary diagnosis. Depending on the cause that caused the enlargement of the spleen, further treatment is carried out by a hematologist, infectious disease specialist, endocrinologist, rheumatologist.

In a normal state, few of us will say exactly where the spleen is located - an element of the lymphatic system that plays an important role in the function of hematopoiesis, cleansing the blood of destroyed blood elements, participating in the process of bile synthesis and metabolism. An increase in this organ (splenomegaly), localized in the abdominal cavity behind the stomach in the region of the left hypochondrium, will immediately force its "owner" to draw attention to itself.

What is a disease

Splenomegaly or enlargement of the spleen is inherently not an independent disease, but a consequence of a number of other ailments. The pathological process involves an increase in the mass of the organ over 600 g, while it can be well felt in the region of the left hypochondrium.

The spleen is located in the region of the left hypochondrium

Splenomegaly has varying degrees of severity - from moderate (mild or insignificant), which can be observed temporarily, to pronounced, when the organ occupies half of the abdominal space. The most severe forms of splenomegaly are observed in oncological lesions of the blood.

Enlargement of the spleen can reach gigantic proportions

Enlargement of the spleen, in turn, disrupts the normal process of hematopoiesis, i.e., the production of blood elements that accumulate and die in the diseased organ, provoking a condition that is dangerous for the health and life of the patient, called hypersplenism.

Possible causes of pathology, including giardiasis and blood diseases

Depending on the causes that caused splenomegaly, pathology is conventionally divided into the following types:

Moderate splenomegaly may be asymptomatic. When the body reaches a significant size, the patient may experience:

bloating;
feeling of pain and discomfort in the left hypochondrium;
lack of appetite;
feeling of rapid satiety;
weight loss;
weakness, dizziness.

These signs develop due to the pressure of the enlarged spleen on the organs of the digestive system. The patient may also have symptoms related to the underlying disease that caused the splenomegaly.

As the organ enlarges, the patient develops sensations of pain and discomfort in the left hypochondrium

All about the spleen - video

Diagnosis methods, including ultrasound

First of all, the doctor will analyze the patient's complaints, conduct an external examination and palpate the spleen area.

The doctor palpates the spleen

To clarify the diagnosis and determine the cause of the disease, the following laboratory tests are performed:

tests for tumor markers;
tests for autoimmune markers;
puncture of the spleen;
CT or MRI provides information about the state of the organ and its surrounding anatomical structures;
radioisotope study provides accurate information about the state of the cells of the spleen.

Treatment methods for the disease

When symptoms of splenomegaly appear, the patient must first contact a therapist who will analyze his condition and refer him to a specialist - a hematologist, endocrinologist, oncologist, etc.

Treatment of pathology is aimed at eliminating the underlying disease by which it is caused. Conservative therapy serves to eliminate the infection, reduce pressure in the corresponding veins, fight the oncological process, etc.

In some cases, it is necessary to resort to splenectomy - removal of the spleen. The surgical method of treatment is used in the following situations:

Traditional medicine

As already mentioned, splenomegaly is not an independent disease and therefore only one that can eliminate the underlying cause of the pathology can be an effective treatment. Of course, folk recipes will not help to cope with such serious diseases as blood cancer, etc. Moreover, they can be used in parallel with the main treatment to maintain the spleen and only after consulting a doctor. Here are some helpful recipes:

Shepherd's Bag Flask. Brew 15 g of grass with a glass of boiling water, let it brew, strain. Drink a tablespoon 4-5 times a day.
Hop cone tincture. Pour three large cones or five small ones with a glass of alcohol or strong vodka and let it brew for 10 days in a dark, cool place. Take three times a day, 40 drops in a small amount of water.
Infusion of nettle leaves, strawberry, string and violet color. Mix the raw materials in equal proportions, then pour two tablespoons of the collection into 0.5 liters of boiling water, wrap and let it brew until cool, then strain and take a glass in the morning and evening. People who are prone to irritation of the mucous membrane of the gastrointestinal tract should exclude nettle from this recipe.

Folk remedies in the treatment of splenomegaly - photo gallery

Shepherd's purse - a remedy for the treatment of splenomegaly Hop cones are used in diseases of the spleen Nettle has a hemostatic effect Strawberries contain many nutrients A succession is a valuable medicinal plant Violet flower remedies are useful for diseases of the spleen

A special diet for splenomegaly is usually not recommended, but it is advisable for the patient to slightly adjust the diet in order to facilitate the work of the body. To activate the function of hematopoiesis, iron, copper, and vitamin C are needed. Considering the fact that excess sugar has a negative effect on the functioning of the spleen, its use should be limited. In addition, the patient is recommended foods rich in pectin to regulate the level of glucose in the body.

So, in the diet of the patient should be present:

dietary meats;
sea fish, seafood;
porridge, primarily buckwheat;
vegetables - cabbage, beets, pumpkin, tomatoes, paprika, etc.;
fruits and berries, primarily pomegranates, citrus fruits, currants, apples;
honey (in the absence of an allergy to it);
ginger;
fruit and vegetable juices, berry fruit drinks;
rosehip decoction;
green tea.

Products recommended for use in splenomegaly - photo gallery

Pomegranate improves the process of hematopoiesis Citrus fruits are a source of vitamin C Buckwheat is rich in iron The patient is recommended dietary meats, including chicken
Fruits and vegetables - a supply of trace elements and vitamins

Foods that are best eliminated from the diet, or at least reduce their consumption:

alcoholic drinks;
canned food, smoked meats;
fatty foods;
products of fast food restaurants;
confectionery;
fresh white bread;
carbonated drinks;
strong coffee and black tea.

Products not recommended for use in splenomegaly - photo gallery

Alcohol negatively affects the liver, which is in close interaction with the spleen.
Black coffee irritates the gastrointestinal tract Carbonated waters contain a lot of sugar and harmful impurities and additives. Confectionery - excess carbohydrates and glucose Smoked meats - a load on the liver

Features of pathology during pregnancy and in children, including infants and newborns

Women diagnosed with severe splenomegaly are advised to refrain from childbearing until the cause of this condition is eliminated. In the case when the disease is detected at an early stage of pregnancy, doctors may decide to terminate it, and for large ones, carry out delivery by caesarean section.

Splenomegaly in children is caused by the same reasons as in adults. The peculiarity is that such a diagnosis to a child can be made erroneously. 35% of newborns, 15% of six-month-old babies, and 3-5% of primary school children may have an enlarged spleen. This fact is not a sign of the disease.

Prognosis and prevention of the disease

The prognosis for splenomegaly depends on the underlying disease. The question of fitness for military service in the army is also considered in this context.

As for the prevention of splenomegaly, it, in fact, does not exist. Moreover, a healthy lifestyle, a balanced diet, the rejection of bad habits and regular medical examinations will help reduce the risk of this disease.

Sports are the basis of a healthy lifestyle

Splenomegaly is not an independent disease, and therefore the most important task is to timely identify the cause that caused the pathology, so that after that immediately proceed to adequate effective treatment.

Spleen- a small unpaired organ located in the hypochondrium on the left. The spleen plays an important role in hematopoiesis - it is in it that lymphocytes are formed and platelets are deposited (accumulated), filtering blood from decaying cells and the body's immune system.

A number of pathological conditions from infectious diseases of the liver to some malignant tumors can lead to an enlargement of the spleen, that is, splenomegaly.

What is splenomegaly?

In a healthy adult, the spleen has a maximum size of about 11 cm and weighs about 150 g. However, in adolescents and adults of a fragile physique, this organ can be determined by palpation, which has no clinical significance.

The diagnosis of splenomegaly is usually made when the spleen reaches a mass of approximately 400-500 grams. However, modern diagnostic methods make it possible to determine the enlargement of the spleen at earlier stages, if the patient develops the appropriate symptoms.

A severe degree of splenomegaly corresponds to the spleen, stretched up to 20 cm (thinning of its membranes is observed) and weighing more than 1000 g.

Disease prevalence

Normally, the spleen is not palpable on palpation. Statistical studies on splenomegaly in the United States have shown that in practice it is possible to probe the spleen, according to various sources, in 2–5% of the population.

It is believed that representatives of all races are equally susceptible to splenomegaly. However, in blacks living in malaria-endemic countries, an enlarged spleen can also be caused by the presence of mutant hemoglobins S and C in the blood.

Separately worth tropical splenomegaly- Enlargement of the spleen, which often occurs in tourists who have visited African countries, and women are twice as likely to suffer from it as men.

Risk factors

Splenomegaly can develop in a person of any age, race or gender, but the following high-risk groups are still distinguished:

Children and young people infected with viral mononucleosis.
Residents and visitors to malaria endemic areas.
Suffering from Gaucher disease, Niemann-Pick and some other hereditary metabolic diseases that affect the state of the liver and spleen.

The reasons

The cause of splenomegaly can be a variety of infections, as well as other diseases associated with hematopoiesis. With timely and properly selected treatment, the spleen returns to its original size after the relief of the underlying disease. Possible reasons include:

Symptoms and methods of diagnosis

Often, an enlarged spleen does not manifest itself in any way and is detected by chance, for example, when examining the abdomen or on an ultrasound of the abdominal cavity for another reason.

However, splenomegaly can cause a number of characteristic symptoms, including:

Pain or feeling of pressure on the left under the ribs, can sometimes radiate to the left shoulder,
Feeling of a full stomach after eating a small amount of food or on an empty stomach, which occurs due to the pressure of the spleen on the stomach,
Anemia,
Fatigue,
Susceptibility to frequent infections
Bleeding.

You can verify the pathological increase in the size of the spleen through the following studies:

A general blood test with a count of erythrocytes, leukocytes and platelets shows changes in the composition of the blood that are characteristic of this disease.
Ultrasound or computed tomography is used to determine the size of the spleen and its impact on neighboring organs.
An MRI may be needed if blood flow through the spleen is to be assessed.

As a rule, the doctor during the examination is not limited to ascertaining the fact of splenomegaly, since this condition is only a symptom of a more serious systemic disease.

A bone marrow aspiration may be needed to determine the cause. Puncture of the spleen is extremely rare due to the high risk of bleeding.

Treatment

Medicines

In cases where the underlying disease causing the growth of the spleen is diagnosed, appropriate medication is prescribed.

antibiotics - for bacterial infections or bacterial endocarditis,
antiviral drugs and interferon - for viral infections,
cytostatics and chemotherapy - for the treatment of leukemia and lymphomas.

Surgery

The only surgical treatment for splenomegaly is splenectomy(splenectomy). Surgery is recommended if the enlarged spleen is pressing on adjacent organs or if there is a high risk of internal bleeding due to trauma.

In a situation where the operation may pose a danger to the patient's weakened body (for example, with leukemia), local irradiation is used.

In order to protect the patient as much as possible in the postoperative period, splenectomy is performed against the background of antibiotic therapy, after vaccination against pneumococcus, meningococcus and Haemophilus influenzae type B.

Treatment with folk remedies

If the enlarged spleen does not cause concern to the patient, then active waiting tactics are used. This means that once every six months or a year, you should visit your doctor for an examination.

Popular folk remedies for the treatment of an enlarged spleen are infusions and decoctions of herbs: St. John's wort, yarrow or calendula. All of these plants have anti-inflammatory effects. It is better to take folk remedies after consulting with your doctor.

Prevention

The only way to prevent splenomegaly is avoidance of infections that can cause it (malaria, etc.) It is also worth taking a responsible attitude to the use of alcohol, as a poor condition of the liver negatively affects the function of the spleen.

Patients with splenomegaly should avoid contact and injury-prone sports(hockey, wrestling), preferring quieter activities.

Any increase in physical activity should be discussed with your doctor. To protect against infections with reduced spleen function or after a splenectomy, it is important to vaccinate in a timely manner in accordance with the national calendar. It will also be optimal to make additional vaccinations in accordance with age.

Forecast

Usually, the prognosis does not depend on the age of the patient or the previous splenectomy, a determined by underlying disease. Accordingly, survival and mortality vary widely depending on the pathological process that caused the enlargement of the spleen, the presence of internal bleeding and organ failure.

Death directly from splenomegaly is extremely rare, but may result from an unsuccessful postoperative period.

An enlarged spleen can suffer as a result of trauma, such as a blow to the abdomen, as its membranes are thinned.

In this case, conservative treatment is usually offered (without surgery), which is selected depending on the condition of the spleen, its membranes and hemostatic function.

Video on the topic: Infectious mononucleosis. What it is?

Secondary pathological syndrome, which is manifested by an increase in the size of the spleen. An increase in an organ of non-inflammatory origin is accompanied by aching pain, a feeling of fullness in the left hypochondrium. In infectious processes, fever, sharp pain in the hypochondrium on the left, nausea, diarrhea, vomiting, and weakness occur. Diagnosis is based on data from a physical examination, ultrasound, spleen scintigraphy, plain radiography and MSCT of the abdominal cavity. Treatment tactics depend on the underlying disease that led to splenomegaly. Etiotropic therapy is prescribed, with irreversible changes and a significant increase in the organ, splenectomy is performed.

General information

Splenomegaly is an abnormal enlargement of the spleen. The syndrome is not an independent nosological unit, but occurs a second time, against the background of another pathological process in the body. Normally, the spleen weighs about 100-150 g and is not accessible for palpation, because it is completely hidden under the rib cage. It is possible to determine the organ by palpation when it is enlarged by 2-3 times. Splenomegaly can be an indicator of serious disease, its prevalence in the general population is 1-2%. In 5-15% of healthy children, hypertrophy of the spleen is determined due to the imperfection of the immune system. The syndrome can occur in people of all ages. Equally affects females and males.

Causes of splenomegaly

The spleen is an important component of the immune system. An increase in functional activity, an increase in the speed of blood flow and the size of an organ accompanies a large number of diseases of both infectious and non-infectious nature. The main reasons for the development of this pathology include:

Treatment of splenomegaly

The tactics of treatment is based on the search and elimination of the causative disease. In infectious processes, therapy is carried out taking into account the causative agent of the disease (antibacterial, antiviral, antiprotozoal drugs, etc.). In autoimmune pathology, hormonal agents are prescribed. For hematological diseases and neoplasms, anticancer drugs, radiation and chemotherapy, bone marrow transplantation are used. Inflammatory splenomegaly with severe symptoms of intoxication require detoxification, anti-inflammatory therapy. Symptomatically prescribe vitamins and mineral complexes, painkillers.

With a large size of the spleen, some accumulation diseases (amyloidosis, Gaucher's disease, etc.), hypersplenism, thrombosis of the portal and splenic veins, the organ is removed (splenectomy). The diet for splenomegaly involves the rejection of fried, smoked, canned foods, and alcoholic beverages. It is recommended to reduce the consumption of pastries, mushrooms, coffee, chocolate, carbonated drinks. Preference should be given to lean meats (rabbit, beef), vegetables (peppers, cabbage, beets), cereals, fruits and berries (citrus fruits, bananas, apples, raspberries, etc.). From drinks it is recommended to use weak tea, fruit drinks and homemade compotes.

Forecast and prevention

Splenomegaly is a syndrome that may indicate serious diseases and therefore requires a thorough diagnosis. Further prospects depend on the initial pathology. Predicting the consequences of the disease is not possible due to the multifactorial nature of this condition. Prevention consists in preventing the development of pathology, which leads to the formation of splenomegaly. For this purpose, annual dispensary observation, timely treatment of acute processes in the body and rehabilitation of chronic foci of inflammation are recommended.