Splenomegaly

Description:

the plenomegaliya is almost always secondary in relation to other diseases which there is a lot of, also as well as possible ways to classify them. Myeloproliferative and limfoproliferativny diseases, accumulation diseases (for example, a disease to Gosha) and diseases of connecting fabric are the most frequent reasons of a splenomegaly in the countries of a temperate climate whereas infectious diseases (for example, malaria, a kala azar) prevail in tropics.

Splenomegaly reasons:

"Working hypertrophy" of a spleen:

- Infectious mononucleosis
- Infectious hepatitis

Immune response:

- Toxoplasmosis
- Cytomegaloviral infection
- Septicaemia
- Bacterial endocarditis
- Typhus
- Tularemia
- Purulent abscess
- Serum disease  
- Tuberculosis
- Sarcoidosis
- Brucellosis
- Malaria
- Histoplasmosis
- Felti's syndrome
- System lupus erythematosus

Hypertrophy in response to destruction of blood cells:

- Inborn spherocytosis
- Autoimmune hemolitic anemia
- Drepanocytic diseases
- Thalassemias and other hemoglobinopathies
- Pernicious anemia (sometimes)
- Autoimmune neutropenia
- Autoimmune thrombocytopenia (seldom)
- Chronic hemodialysis

Congestive splenomegaly:

- Cirrhosis
- Thrombosis splenic vein
- Obstruction of a portal vein
- Chronic heart failure (seldom)

Myeloproliferative splenomegaly:

- Myeloid metaplasia of an unspecified etiology
- Myelosis
- Osler's disease

Splenomegaly at tumors:

- Lymphoma: "hairy cell" leukosis
- Acute lymphocytic or monocytic leukosis
- Chronic lymphoid leukosis
- Cancer metastasises (seldom)
- Angiosarcoma (seldom)
- Macroglobulinemia

Splenomegaly at accumulation diseases:

- Disease to Gosha
- Amyloidosis
- Histiocytosis of X

Other causes:

- Cysts (true, false, parasitic)
- Nediagiostirovanny rupture of a spleen
- Thyrotoxicosis
- Not tropical idiopathic splenomegaly

Splenomegaly symptoms:

The splenomegaly is criterion of a hypersplenism; the sizes of a spleen correlate with anemia degree. It is possible to expect increase in the sizes of a spleen about 2 cm lower than a costal arch on each 1 g of decrease in hemoglobin. Other clinical signs, as a rule, depend on manifestations of a basic disease, spleen pain is sometimes observed. Until other mechanisms do not aggravate manifestations of a hypersplenism, anemia and other types of a cytopenia are moderated also bessimptomna (for example, number of thrombocytes from 50 000 to 100 000/mkl, number of leukocytes of 2500 to 4000/mkl with a normal leukocytic differentiation). Morphology of erythrocytes usually normal, except for seldom met spherocytosis. The reticulocytosis is an everyday occurrence.
The hypersplenism is suspected at patients with a splenomegaly, anemia or a cytopenia; diagnosis is similar to a situation with a splenomegaly.

Diagnosis:

In need of confirmation of a splenomegaly in cases of doubtful result after preliminary survey ultrasonography is a choice method in connection with its high precision and low price. KT and MRT are capable to provide more detailed image of body. MRT is especially effective when determining portal thrombosis or thrombosis of a splenic vein. The radio isotope research is the high-precision diagnostic method capable to identify additional details of splenic fabric, but a method very expensive and difficult for performance.
The specific reasons of a splenomegaly established at clinical examination have to be confirmed with the corresponding inspections. In the absence of the visible reason of a splenomegaly first of all it is necessary to exclude existence of an infection as at the same time the early initiation of treatment unlike other reasons of a splenomegaly is necessary. Inspection has to be the fullest in zones of high geographical spread of an infection in case the patient has clinical signs of an infection. It is necessary to obtain data of the general analysis and crops of blood, a marrow research. If the patient does not feel ill, there are no disease symptoms, except for the symptoms caused by a splenomegaly and there was no risk of infectious defeat, there is no need for use of a wide range of researches, except performance of the general blood test, a smear of peripheral blood, tests of function of a liver, KT of abdominal organs and ultrasonography of a spleen. At suspicion on a lymphoma performance of a floutsitometriya of peripheral blood is shown.
Specific deviations in the analysis of peripheral blood can indicate the defeat reason (for example, a lymphocytosis - a chronic lymphoid leukosis, a leukocytosis with existence of unripe forms - other types of leukoses). The increased maintenance of basophiles, eosinophils, a kernel - the containing erythrocytes or erythrocytes in the form of "the falling drop" assumes existence of a myeloproliferative disease. The cytopenia indicates a hypersplenism. The spherocytosis assumes existence of a hypersplenism or hereditary spherocytosis. Functional hepatic tests will have deviations at a congestive splenomegaly with cirrhosis; the isolated increase in a serumal alkaline phosphatase indicates possible infiltration of a liver as a result of a myeloproliferative, limfoproliferativny disease or miliary tuberculosis.
Some other researches can be useful even at patients with lack of symptoms of diseases. The electrophoresis of serumal proteins identifies a monoclonal gammapathy or decrease in level of immunoglobulins, possible in the presence of limfoproliferativny diseases or an amyloidosis; the diffusion hypergammaglobulinemia assumes existence of persistent infection (for example, malaria, the Indian visceral leushmaniosis, a brucellosis, tuberculosis), cirrhosis with a congestive splenomegaly or diseases of connecting fabric. Increase in level of uric acid of blood serum assumes existence of a myeloproliferative or limfoproliferativny disease. Increase in level of an alkaline phosphatase of leukocytes indicates a myeloproliferative disease whereas at decrease in its level existence of a myelosis is possible.
If inspection did not reveal any deviations, except a splenomegaly, the patient needs to be inspected in the range from 6 up to 12 months or again at emergence of new symptoms.
The splenomegaly increases splenic mechanical filtering and destruction of erythrocytes, and also often leukocytes and thrombocytes. The compensatory hyperplasia of marrow of those cellular lines which level is reduced in circulation is shown.

Treatment of a splenomegaly:

Treatment of a splenomegaly is directed to a basic disease. The increased spleen does not need treatment until the heavy hypersplenism develops. The patient with the spleen available to a palpation or reached very big sizes, it is necessary to avoid, apparently, contact sports to avoid risk of its gap.