According to AbbreviationFinder.org, hepatosplenomegaly is the medical term for a simultaneous enlargement of the spleen and liver. This combination of symptoms can have a wide variety of causes, such as infectious connections or hereditary storage diseases. Treatment of symptoms depends on the primary disease.
What is hepatosplenomegaly?
Hepatosplenomegaly is not a disease itself. Rather, it is a symptom of various diseases. Hepatosplenomegaly is always referred to when a patient shows simultaneous swelling and enlargement of the spleen and liver.
The symptom is actually two different symptoms or a combined symptom complex of an enlarged liver in the sense of hepatomegaly and an enlarged spleen in the sense of splenomegaly. The simultaneous presence of these symptoms is clinically relevant, as it can provide the doctor with an indication of the larger scope of the primary disease against the background of the medical history.
Hepatosplenomegaly is acquired in most cases and, as an acquired symptom complex, is usually due to infections. The congenital form of both symptoms in infants is often caused by storage diseases or lymphatic system diseases. The age of the affected person is therefore particularly relevant for the diagnosis of a primary disease.
Causes
Hepatosplenomegaly can have a variety of causes. The acquired form often resolves with viral infections such as Epstein-Barr virus or cytomegalovirus. A connection with bacterial infections is also conceivable in the acquired form. In addition to brucellosis, the symptom combination characterizes, for example, ornithosis, parasitosis, malaria and schistosomiasis or leishmaniasis.
If the acquired form occurs without infections, tumors can be the cause. The congenital form of the two symptoms primarily points to storage diseases such as amyloidosis or mucopolysaccharidosis. Diseases of the lymphatic system are also possible causes of congenital enlargement of the spleen and liver.
Other causal relationships may include neuroblastoma, sarcoidosis, syndromes such as Hurler syndrome or Schnitzler syndrome, Farber disease, and preductal coarctation of the coarthmus. Apart from that, the combined symptoms are often present in hepatolienal diseases such as right heart failure or in liver diseases. In addition, blood disorders such as polycythemia vera have been linked to the phenomenon. Identifying the cause is crucial to developing appropriate therapeutic steps.
Symptoms, Ailments & Signs
The symptoms of hepatosplenomegaly depend greatly on the particular cause in the individual case. Basically, the enlargement of the spleen and liver usually does not cause any pain and can even be completely symptom-free in isolation. The swellings are often visible to the naked eye. Depending on the extent of the swelling, the phenomenon can compress neighboring organs of the liver and spleen. In such a case, functional losses of the compressed organs are usually associated.
In the case of extremely massive swelling, there is also pain. For the doctor, the accompanying symptoms of the enlargement of the spleen and liver are one of the most important clues to the actual cause of the disease. For example, infectious diseases are often associated with inflammation, redness and local pain or coughing, hoarseness and a runny nose. In addition, fever is a frequent accompanying symptom of infectious hepatosplenomegaly.
If a cardiac congestion is responsible for the enlargement of the two organs, upper abdominal pain is the most common accompanying symptom. To list all possible concomitant symptoms of hepatosplenomegaly at this point would go beyond the scope and makes little sense, since the clinical picture can be characterized by almost all symptoms, depending on the cause.
Diagnosis & History
The first suspicion of hepatosplenomegaly usually comes to the doctor through visual diagnosis and palpation. Physical examination in the form of palpation and percussion reveals enlargement of the liver. Palpation of the spleen with the patient in the right lateral position provides evidence of the enlargement of the spleen. Sonography confirms the diagnosis. In addition to determining the size, the ultrasound also helps to determine the internal and surface structure of the two organs.
A sonographic examination of the arteries and veins can be used to identify or rule out causes such as hepatic vein congestion or portal vein enlargement. As an alternative to ultrasound, a CT can be performed. The laboratory values are particularly relevant for the causal diagnosis, above all the metabolic parameters, the immunological parameters and, if necessary, the tumor markers.
The blood test can also be used to determine or rule out infectious causes. Procedures such as liver puncture or bone marrow puncture may be necessary to further investigate the cause.
Complications
Since hepatosplenomegaly is a complex symptomatic disease that should be considered an indicator of serious health problems, the type of treatment is not aimed at hepatosplenomegaly itself, but at eliminating the cause. Therefore, the complications that occur in the course of therapy are dependent on it and are of a correspondingly diverse nature.
Untreated hepatosplenomegaly can lead to various complications. These include internal bleeding and the appearance of blood in the stool and vomit. Organs that are in the immediate vicinity of the enlarged spleen and liver can be compressed and their function impaired as a result.
Liver insufficiency and liver failure can also occur, which in turn can lead to jaundice or blood clotting disorders, as well as changes in consciousness. These range from mood swings and sleep disorders to states of confusion and coma. Leg edema and congested neck veins can also be observed as complications.
In addition, fine motor skills can be disturbed, which manifests itself in strong trembling of the hands. Another serious complication that can occur as a result of hepatosplenomegaly is encephalopathy, i.e. a pathological change in the entire brain. This is based on a disorder of the brain cells, which can no longer adequately fulfill their respective function; this dysfunction may or may not be permanent.
When should you go to the doctor?
A doctor should be consulted as soon as unusual swelling is noticed in the area of the upper body. If there is pain, a feeling of pressure or an incomprehensible inner tension, a doctor’s visit is necessary. If the complaints begin to spread or increase in intensity, an inspection visit must be carried out. If there are circulatory disorders, tachycardia or circulatory problems, a medical examination is required.
Complaints such as fever, a general feeling of illness, dizziness or reduced performance must be examined and treated by a doctor. In case of vomiting, loss of appetite or insomnia, a doctor’s visit is necessary. Particular caution is required if blood occurs repeatedly in the urine or stool. A doctor should be consulted as soon as possible so that the cause can be determined. The affected person needs immediate medical attention if they are confused, dizzy or have a loss of consciousness.
It is advisable to call an ambulance and ensure first aid is available until he arrives. Noticeable skin changes should also be examined by a doctor. Skin discoloration, pimples, or edema are considered unusual and should be investigated. If swelling of the legs occurs that leads to motor problems or if the person concerned suffers from exhaustion or apathy for several days, a doctor should be consulted.
Treatment & Therapy
Hepatosplenomegaly is not treated symptomatically. All treatment measures are aimed at eliminating the cause and thus correspond to causal therapy. The treatment depends so much on the actual trigger of the organ enlargement. If infections have caused the enlargement, the administration of antibiotics, for example, is an important step in therapy.
Drug therapy can also be used for cardiac causes such as backflow from the heart. Under certain circumstances, such causes may also require surgical treatment, such as heart valve replacement or therapeutic steps such as stenting. A causal therapy is not possible for storage diseases and hereditary congenital syndromes.
In this case, the cause of the organ enlargement cannot be eliminated. Depending on the clinical picture, such diseases are treated symptomatically. If the hepatosplenomegaly is due to a tumor, the focus of therapy is excision of the tumor. Depending on the type of growth, further treatments such as radiation therapy may be carried out afterwards.
Outlook & Forecast
The prognosis of hepatosplenomegaly always depends on the underlying disease. The combined enlargement of the liver and spleen is just a symptom that points to another disease. If the underlying disease is successfully treated, hepatosplenomegaly will also disappear.
The causes are manifold. These can be viral infections, bacterial infections, parasitosis, tumors, storage diseases, diseases of the lymphatic system and many other triggering diseases. The prognosis of hepatosplenomegaly cannot be made separately from the prognosis of the individual underlying disease.
The prognosis for certain infectious diseases is very good. This applies, among other things, to glandular fever (Epstein-Barr virus). However, severe infections and parasitoses such as brucellosis, ornithosis, malaria, leishmaniasis or schistosomiasis often also play a role.
The prognosis of each disease varies. The prognosis for tumors and diseases of the lymphatic system is even worse, although differentiation must also be made here. Among other things, the storage diseases cannot be cured and often lead to permanent hepatosplenomegaly.
Many diseases are also genetic. Congenital causes of hepatosplenomegaly also include preductal and postductal coarctation of the coarctation. This form of hepatosplenomegaly is very life-threatening. The lethality is around 90 percent if there is no therapy. However, both forms of stenosis can be successfully treated by surgery.
Prevention
Hepatosplenomegaly can have so many causes that not all preventive measures can be listed here. Genetic causes cannot be prevented. Some of the infectious causes can be prevented by vaccination. Congestion or cardiac conditions can be prevented in moderation through healthy eating, exercise and antihypertensive measures.
Aftercare
In most cases, the person affected with hepatosplenomegaly has no special or direct measures or options for aftercare. The most important thing is a quick and, above all, early diagnosis, so that the symptoms do not worsen or other complications occur. For this reason, the patient should consult a medical professional at the very first symptoms and signs of hepatosplenomegaly in order to prevent further complications or discomfort.
In the treatment of hepatosplenomegaly, many regular visits to a doctor are necessary. The internal organs must be examined regularly in order to quickly identify the underlying disease. The disease itself is treated with medication. Those affected should ensure that they are taken regularly and that the dosage is correct in order to properly alleviate the symptoms.
If antibiotics are taken, it is advisable not to consume alcohol in order not to reduce the effectiveness of the antibiotics. In many cases, patients with this disease depend on the support and help of friends and their own family. This can also prevent mental upsets or depression.
You can do that yourself
Medical treatment of hepatosplenomegaly focuses on eliminating the causes. The patient can take some measures to relieve each symptom and discomfort. In addition to medicines prescribed by a doctor, gentle preparations such as St. John’s wort capsules or valerian tea help against the typical sleep disorders.
Mood swings can also be alleviated by natural tranquilizers. Physical activity and an overall healthy and balanced lifestyle also help to ensure that irritability, tiredness and other typical symptoms subside quickly.
Should states of confusion set in, one must act prudently in everyday life in order to avoid accidents. Other complaints such as blood clotting disorders or changes in consciousness require medical treatment. The patient should inform the doctor of any symptoms and go to a hospital if symptoms worsen.
Although the simultaneous enlargement of the spleen and liver is not life-threatening, the symptoms nevertheless represent a considerable burden for the patient. Psychological support is therefore sensible and necessary. Talking to other affected people, for example in internet forums or in a self-help group, makes it easier to deal with the disease and shows new ways of dealing with it.