Splenomegaly

Introduction Splenomegaly is an important pathological sign. Under normal circumstances, the spleen is generally not touched. If the supine or lateral position can touch the edge of the spleen, the spleen should be considered enlarged. Increased spleen volume is the main manifestation of spleen disease. People with low diaphragmatic or thin body, especially women, can even touch the edge of the spleen, but it is quite soft and has no tenderness, which is different from pathological splenomegaly. Different causes cause spleen and its texture can vary to varying degrees.

Cause

Infectivity

(1) Acute infection: It is found in viral infection, rickettsial infection, bacterial infection, spirochete infection, and parasitic infection.

(2) Chronic infection: found in chronic viral hepatitis, chronic schistosomiasis, chronic malaria, and black fever.

2. Non-infectious

(1) congestion: seen in cirrhosis, chronic congestive right heart failure, chronic constrictive pericarditis or a large number of pericardial effusion, idiopathic non-sclerosing portal hypertension.

(2) Hematological diseases: found in various types of acute and chronic leukemia, erythroleukemia, red blood disease, malignant lymphoma, malignant histiocytosis, idiopathic thrombocytopenic purpura, hemolytic anemia, polycythemia vera, multiple Myeloma, hypersplenism, etc.

an examination

Laboratory tests have important implications for the diagnosis of splenomegaly, including routine blood tests, platelet counts, reticulocyte counts, and eosinophil counts. Hemoglobin electrophoresis, erythrocyte fragility test, acid hemolysis (Ham), direct anti-human globulin. Blood parasites, protozoan tests, liver function tests, bone marrow tests, or bone marrow biopsy. Serological antigen antibody examination; lymph node puncture or biopsy, splenectomy or biopsy, routine examination of ascites.

The necessary equipment examination has important diagnostic value for determining the cause of splenomegaly. Commonly used examination methods include B-mode ultrasound, echocardiography, X-ray, CT, magnetic resonance, endoscopy, and inferior vena cava angiography.

For the diagnosis of splenomegaly, first determine whether it is splenomegaly, the degree of splenomegaly, and texture. The second step is to understand the accompanying symptoms and signs of splenomegaly. By understanding the medical history, the physical examination can make a preliminary diagnosis of the cause of the splenomegaly, and then selectively perform laboratory tests and necessary equipment examinations, and finally diagnose the cause of the splenomegaly.

Differential diagnosis

1. Infectious spleen: clinical manifestations of fever, rash, skin stasis, liver and spleen and lymph nodes, splenomegaly is generally mild, soft. Such diseases include typhoid fever, sepsis, viral hepatitis, bacterial endocarditis, malaria and the like, and diagnosis can usually be made by detecting the corresponding pathogen.

2. Liver cirrhosis: history of hepatitis or schistosomiasis infection, slow onset, clinical manifestations of weight loss, fatigue, loss of appetite, abdominal discomfort, bleeding tendency, ascites, etc., physical examination of abdominal wall varices, splenomegaly, mostly light, Moderate swelling, schistosomiasis liver fibrosis can be expressed as a spleen, advanced spleen hyperfunction. Diagnosis can be made by medical history, clinical manifestations, liver function tests, and B-ultrasound.

3. Chronic hemolytic anemia: splenomegaly caused by hemolysis, usually mild to moderate swelling, symptoms such as anemia, jaundice, etc., laboratory examination may have increased reticulocyte, bone marrow young red hyperplasia active, serum Increased indirect or unconjugated bilirubin and increased urinary biliary.

4. Leukemia: The course of acute leukemia develops rapidly, manifesting as symptoms of infection, anemia, hemorrhage, etc. The spleen is slightly swollen; the onset of chronic leukemia is slow, and the spleen can be highly swollen as the disease progresses. Peripheral blood examination can be seen in immature early white blood cells. A large number of primordial cells or immature white blood cells can be seen in the bone marrow. Generally, various types of leukemia can be distinguished according to peripheral blood and bone marrow puncture.

5. Malignant lymphoma: Malignant lymphoma is characterized by painless local or systemic lymphadenopathy with fever and enlarged liver. The spleen is mostly mild and moderately swollen. Lymph node biopsy and bone marrow smears can be found in RS cells or lymphoma cells.

6. Malignant histiocytosis: clinical manifestations of unexplained fever, failure, complete blood cell reduction, liver and spleen, etc., even the spleen can be significantly enlarged, usually multiple, multi-site bone marrow smear or lymph node biopsy can find malignant Tissue cells can establish a diagnosis. Decreased alkaline phosphatase activity in peripheral blood neutrophils can assist in diagnosis.

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