Hepatosplenomegaly (Enlarged Liver and Spleen)

What is Hepatosplenomegaly?

Hepatomegaly is the medical term used to describe enlargement of spleen and liver. The term ‘Hepatosplenomegaly’ is the enlargement of both spleen and the liver simultaneously.

The term ‘ hepatosplenomegaly’ was originated from three greek words;

• Hepato from hepatikos meaning, of the liver
• Spleno from spleen meaning , the spleen
• Megaly from megas meaning, big

Structure of Liver

The liver consists of four lobes; the large right lobe, left lobe and two smaller lobes that lie behind the right lobe.

Each lobe is made up of 50,000- 1,00,000 lobules. Each lobule consists of a central vein and the hepatic cells that perform the functions of the liver.

Structure of Spleen

The structure of spleen is similar to that of a lymph node. Spleen is a vascular organ with rich blood supply.

The spleen consists of;

White pulp– white pulp is made up of lymphocytes and functions similar to lymph nodes.

Red pulp– The red pulp surrounds the white pulp and mainly contain blood vessels and macrophages.

Hepatosplenomegaly in children

Hepatosplenomegaly in children is associated with many disorders like;

In newborns, thalssemia, and storage disorders are the major reason for hepatosplenomegaly. In older children, malaria, kala azar, enteric fever and sepsis causes hepatosplenomagaly.

Effect of Hepatosplenomegaly in infants

In infants with inherited hepatosplenomegaly, the liver cannot process glucocerebroside. As a result there will be severe damage to the central nervous system of infants.

What are the causes of Hepatosplenomegaly?

The hepatosplenomegaly causes can be divided into;

Hepatosplenomegaly due to infection

• Viral infection– Viral infection like hepatitis, rubella, cytomegalovirus disease, infectious mononucleosis etc can cause hepatosplenomegaly.
• Bacterial infection– cat scratch disease is a bacterial infection that causes hepatosplenomegaly.
• Parasite infections– Parasitic infections like malaria and leischmaniasis can cause hepatospenomegaly.

Liver disorders that causes Hepatosplenomegaly

The major liver disorders that cause hepatosplenomegaly are;

• Hepatitis C– Hepatitis C is a viral liver disease that is transmitted through blood. There are many symptoms for Hepatitis C, most of which directly affect the liver and spleen. Other symptoms of Hepatitis C include yellowish discoloration of skin and eyes, dark urine, fever and abdominal pain.

• Cirrhosis of Liver– Cirrhosis of liver causes enlarged liver and spleen. When a normal healthy liver is affected by cirrhosis, the cells are replaced by scar tissues and these scar tissues try to take over the function of the liver. This attempt by the scar tissues fails due to lack of blood supply.

• Biliary Atresia– Biliary atresia is a condition in which the tubes that carry bile pigment from gall bladder to liver gets blocked.

• Hepatocellular Carcinma– abnormal growth or cancer of liver cells.

• Portal Hypertension– increased pressure in the blood vessels supplying blood to the liver.

• Blockage in the bile duct.

• Obstruction in portal vein that supplies blood to the liver.

Malignancies that causes Hepatosplenomegaly

• Leukemia, lymphoma, histiocytic syndromes etc are cancerous conditions that cause hepatosplenomegaly.

Immunological causes of Hepatosplenomegaly

Ommen syndrome and hereditary neutrophilia are disorders of immunological system that causes hepatosplenomegaly.

Congestive causes of Hepatosplenomegaly

Constrictive pericarditis and hepatic vein obstruction are the congestive causes of hepatosplenomegaly.

What are the symptoms of Hepatosplenomegaly?

The major hepatosplenomegaly symptoms include;

• Abdominal pain- Abdominal pain in the upper right region is the common symptom of hepatosplenomegaly.
• Abdominal tenderness- Right region of the abdomen, tender on percussion.
• Nausea
• Vomiting
• Abdominal swelling
• Fever
• Itching
• Jaundice- yellow eyes and skin
• Brown urine and clay colored stool

Finding out the Liver swelling

Liver is located below the ribcage at the right side of the abdomen. Normally, the edge of the liver comes close to lower edge of the ribcage. The edge of the liver is firm and thin, and cannot be felt with fingers in a disease free state. When the liver is enlarged, it can be felt at the upper right of the abdomen, just below the ribs.

The medical history questions that the doctor many ask the hepatosplenomegaly patient

• Do you experience abdominal pain?
• Did you notice any color change in the skin or eyes?
• Did you experience vomiting or fever?
• What are the drugs that you are taking currently?
• Are you an alcoholic?
• What are the other symptoms you have noticed?

What are the risk factors associated with Hepatosplenomegaly?

The main hepatosplenomegaly risk factors are;

• Obesity
• Alcohol addiction
• Liver cancer
• Hepatitis
• Diabetes
• High cholesterol

Hepatosplenomegaly Diagnosis

There are a number of diagnostic testsfor hepatosplenomegaly to be performed to confirm the exact cause of the disease.

The hepatosplenomegaly diagnosis tests include;

• Blood film
• Monospot test
• Hepatitis tests
• Bone marrow aspiration
• Test for malaria
• Urinalysis
• Ultrasound scan
• Needle aspiration
• CT scan

Hepatosplenomegaly Differential Diagnosis

There are many diseases in which hepatosplenomegaly is an associated condition. The common disorders in the hepatosplenomegaly differential diagnosis are;

• Hepatitis
• Thrombocytopenia
• Cirrhosis of the liver
• Chronic hepatitis C
• Hepatoma
• Liver cancer
• Polycythemia
• Reyes syndrome
• Vitamin A overdose
• Wilson’ disease

When to consult a doctor?

The hepatosplenomegaly is generally found out by the physician. If you experience any of the symptoms of hepatosplenomegaly, consult a doctor immediately.

What are the complications associated with Hepatosplenomegaly?

Hepatosplenomegaly is a complicated disorder often an indication of some serious medical conditions. The complications of hepatosplenomegaly include;

• Bleeding
• Blood in stool
• Blood in vomit
• Liver failure
• Encephalopathy

Hepatosplenomegaly Treatment

The treatment of hepatosplenomegaly mainly depends on the cause of hepatosplenomegaly. The treatments for hepatosplenomegaly include;

• Avoiding alcohol
• Avoiding drugs that make liver to over work
• Treatment of liver diseases

References:

http://www.medcyclopaedia.com/library/topics/volume_vii/h/hepatosplenomegaly.aspx

http://www.bettermedicine.com/article/enlarged-liver-and-spleen/causes