Splenomegaly
Introduction
Introduction to the spleen 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 a major manifestation of spleen disease. basic knowledge Sickness ratio: 0.1% Susceptible people: no special people. Mode of infection: non-infectious Complications: anemia, hemolytic anemia
Cause
Splenomegaly
Infectivity (30%):
(1) Acute infection: seen in viral infection, rickettsial infection, bacterial infection, spirochete infection, parasitic infection.
(2) Chronic infection: seen in chronic viral hepatitis, chronic schistosomiasis, chronic malaria, kala-azar, syphilis, etc.
Non-infectious (20%):
(1) Congestion: seen in cirrhosis, chronic congestive right heart failure, chronic constrictive pericarditis or massive pericardial effusion, Budd-Chiari syndrome, idiopathic non-sclerosing portal hypertension.
(2) Hematological diseases: seen in various types of acute and chronic leukemia, erythroleukemia, red blood disease, malignant lymphoma, malignant histiocytosis, idiopathic thrombocytopenic purpura, hemolytic anemia, polycythemia vera, bone marrow fiber , multiple myeloma, systemic tissue mast cell disease, hypersplenism.
(3) connective tissue diseases: such as systemic lupus erythematosus, dermatomyositis, nodular polyarteritis, juvenile rheumatoid arthritis (Still disease), Felty disease and the like.
(4) Histiocytosis: such as Leter-Siwe's disease, yellow lipoma disease (Han-Xue-Ke) syndrome, eosinophilic granuloma.
(5) Lipid deposition: such as Gaucher disease (high snow disease), Niemann-Pick disease.
(6) spleen tumor and spleen cyst: spleen malignant tumor is rare in primary, malignant tumor metastasis to the spleen is also rare, primary cancer is mostly located in the digestive tract, spleen cyst is rare, true and pseudocyst, true cyst For epidermal cysts, endothelial cysts (such as lymphatic cysts) and parasitic cysts (such as hydatidosis), pseudocysts are classified as hemorrhagic, serum or inflammatory.
Tumor and cystic expansion of the spleen itself (20%):
Tumors and cystic dilatation of the spleen are rare. There are reports of primary spleen malignant lymphoma. Cystic dilatation is seen in dermoid cysts, lymphatic cysts and parasitic cysts (cysticercosis). Pseudocysts such as: Malaria, schistosomiasis, etc. can be caused by bleeding, inflammation, serum and other reasons.
Pathogenesis
There are many causes of splenomegaly, and the mechanism of splenomegaly caused by each disease is also different. Sometimes the mechanism of a disease causing splenomegaly may be a variety of factors, and its mechanism is summarized as follows:
1. Spleen enlargement caused by infiltration of cell infiltration is seen in various inflammatory cell infiltration, eosinophil infiltration, leukemia cell infiltration, various tumor cell infiltration, inflammatory cell infiltration is more common in acute infectious diseases, often accompanied by Spleen is obviously congested, eosinophil infiltration is seen in eosinophilia and partial lipid deposition; splenomegaly caused by infiltration of various leukemia cells, most obvious in chronic myeloid leukemia, followed by chronic lymphocytic leukemia Acute lymphocytic type is more obvious, followed by acute myeloid leukemia and acute monocytic leukemia, various tumor cell infiltration, malignant tumor of the spleen itself is rare, primary in the lymphatic system, bone marrow and intestine Malignant tumors can invade the spleen. For example, spleen infiltration occurs in lymphoma cells of malignant lymphoma. Among them, Hodgkin's disease is more affected by spleen, accounting for about 50%. Occasionally, simple spleen Hodgkin's disease can be used. Table existing spleen; multiple myeloma bone marrow cancer cells infiltration; malignant histiocytosis malignant tissue cell infiltration; intestinal malignant tumor transfer When moved to the spleen, splenomegaly can occur due to infiltration of tumor cells.
2. Spleen congestion The spleen is the largest blood storage organ in the body. The blood flow of the spleen caused by various reasons is blocked, which can cause congestion and swelling of the spleen, such as cirrhotic portal hypertension, portal vein and inferior vena cava thrombosis. Tumor emboli, congenital or acquired vascular malformations; right heart failure caused by various causes, constrictive pericarditis or massive pericardial effusion can cause spleen congestion and swelling.
3. Extramedullary hematopoietic spleen is a hematopoietic organ. In the case of myeloproliferative diseases, the spleen restores its hematopoietic function. Different degrees of extramedullary hematopoiesis lead to splenomegaly, especially in extramedullary hematopoiesis. Big and obvious.
4. Histiocytosis Histiocytosis is caused by abnormal proliferation of tissue cells, involving multiple organs of the body, especially in the liver, spleen, lymph nodes, bone marrow, skin, thymus, etc., which can manifest obvious splenomegaly, such as: Le-snow disease, Han-Snow-Ke disease, chronic infectious diseases, kala-azar, connective tissue disease, Felty, Still disease, rheumatoid arthritis, etc. can cause spleen enlargement of spleen tissue cells and splenomegaly.
5. Fibrous tissue hyperplasia Due to long-term chronic stimulation of long-term chronic congestion, chronic infection, cell infiltration and other causes, abnormal proliferation of tissue cells leads to a large proliferation of spleen fibrous tissue, which causes the spleen to enlarge and become hard.
6. Lipid metabolism disorder due to lack of lipid metabolism enzymes or dysfunction, causing lipid metabolism disorder, lipid deposition in tissues causes splenomegaly, such as: Gaucher disease is an autosomal recessive lipidoid metabolic disorder Because -glucocerebrosidase can not convert glucocerebroside into galactocerebroside, as a result, a large amount of brain cerebrosides are accumulated in tissue cells, and the chronic type shows giant spleen, and Niemann-Pick disease is lipid. Metabolic disorders involve the mononuclear macrophage tissue of the internal organs. This disease may be due to the lack of neurophospholipidase, so that the neurolipids are stored in the liver, spleen and nervous system macrophages, resulting in a significant increase in spleen.
Prevention
Spleen prevention
Usually develop good habits, not picky eaters, balance nutrition, maintain hygiene, and prevent infection. Once found, go to the hospital immediately to check the treatment.
Complication
Splenomegaly complications Complications anemia hemolytic anemia
Spleen with fever, can be seen in a variety of acute and chronic infectious diseases; splenomegaly with anemia, fever, bleeding tendency often suggest leukemia splenomegaly; splenomegaly with anemia, yellow staining suggests hemolytic anemia; spleen rhubarb often prompts chronic hepatitis or cirrhosis Spleen with gastrointestinal symptoms or hematemesis may be cirrhotic portal hypertension; congestive splenomegaly caused by heart disease or pericardial effusion often have difficulty breathing, palpitations, shortness of breath and other symptoms.
Symptom
Symptoms of splenomegaly common symptoms lymphadenopathy, hyperemia, nodular, portal hypertension, jaundice, erythrocytosis, bacterial infection, amyloidosis, sepsis
The splenomegaly mainly depends on palpation examination. When the palpation method is not diagnosed, the spleen's dullness can be checked by the percussion method. (The normal spleen is in the middle of the left sacral line between the 9th and 11th ribs; the width is 4~7cm. , the front does not exceed the front line), if necessary, ultrasound, X-ray, CT, etc. can be used to determine the size and shape of the spleen. When the splenomegaly is found by palpation, pay attention to the degree and quality of the spleen, and pay attention to whether there are other Accompanied by signs.
1. The extent of splenomegaly The extent of splenomegaly is associated with disease.
(1) mild splenomegaly: the lower edge of the spleen is 2 to 3 cm below the costal spleen at deep inhalation, which can be seen in some viral infections, bacterial infections, rickettsia infection, early schistosomiasis, congestive Heart failure, cirrhosis, portal hypertension, Hodgkin's disease, juvenile rheumatoid arthritis, systemic lupus erythematosus, tropical eosinophilia, idiopathic thrombocytopenic purpura.
(2) Moderate splenomegaly: the lower margin is 3cm below the costal margin and the flat umbilical is moderately enlarged. It can be seen in acute myeloid leukemia, acute lymphocytic leukemia, chronic hemolytic anemia, infectious mononucleosis. , vitamin D deficiency, spleen amyloidosis, malignant lymphoma, Niemann-Pick disease.
(3) Extreme splenomegaly: the lower margin is below the umbilical level and is extremely splenomegaly or giant spleen, which can be seen in chronic myeloid leukemia, chronic malaria, advanced schistosomiasis, spotted disease, myelofibrosis, polycythemia vera, Mediterranean Anemia, Gaucher disease, etc.
2. The quality of the spleen The spleen may have different degrees of quality due to different causes. The splenomegaly caused by acute infection is soft; the chronic spleen caused by infiltration of leukemia cells and tumor cells is hard and the surface is uneven. The spleen of liver cirrhosis is moderately hard; the quality of congestive spleen is different due to the degree of congestion and the length of congestion. The time is short, the blood is light, the quality is soft, the time is long or the heavyness of the blood is hard, but it is generally full. Sense, cystic enlargement has sacral surface roughness, it must be pointed out that the degree and quality of splenomegaly are not only different due to different causes, but also may vary due to different course of disease, treatment and individual responsiveness. Pay attention to these factors.
3. Along with the various signs of different signs, there are different accompanying signs in the spleen.
(1) anemia, bleeding spots or ecchymoses: seen in hematological splenomegaly, such as various types of leukemia, idiopathic thrombocytopenic purpura.
(2) anemia, jaundice: seen in hemolytic anemia, chronic viral hepatitis, cirrhosis, malignant histiocytosis, sepsis.
(3) Liver and lymphadenopathy: seen in malignant lymphoma, lymphocytic leukemia, connective tissue disease, infectious mononucleosis, sarcoidosis and some infectious diseases.
(4) liver disease face, liver palm and spider mites: found in chronic viral hepatitis, cirrhosis.
(5) various types of rash: more common in various infectious diseases, or infectious diseases, such as typhoid, typhus, brucellosis, sepsis, subacute infective endocarditis.
(6) edema and ascites: seen in chronic right heart failure, constrictive pericarditis, cirrhosis, portal hypertension, inferior vena cava obstruction.
(7) Heart enlargement: seen in a variety of heart disease caused by chronic heart failure, a large number of pericardial effusion caused by various reasons.
Examine
Splenomegaly
Laboratory tests have important implications for the diagnosis of splenomegaly, including routine blood tests, platelet counts, reticulocyte counts, eosinophil counts, and careful blood cell classification to facilitate the discovery of pathological blood cells and other abnormal cells, hemoglobin electrophoresis. , erythrocyte fragility test, acid hemolysis (Ham), direct anti-human globulin (Comb's), blood parasites, protozoan examination, liver function tests, bone marrow examination or bone marrow biopsy, serological antigen antibody test; lymph node puncture or biopsy, spleen Puncture or biopsy, routine examination of ascites, etc., the above laboratory tests can be based on the history of the body, preliminary diagnosis, targeted selection, for some diseases can often find a basis for a definite diagnosis.
The necessary equipment examination has important diagnostic value for determining the cause of splenomegaly. Commonly used examination methods are: B-mode ultrasound, echocardiography, X-ray examination, CT examination, magnetic resonance examination, endoscopy, Inferior vena cava angiography.
For the diagnosis of splenomegaly, it is inseparable from the above aspects, but in the process of thinking, there must be primary and secondary, first determine whether the spleen is swollen, the degree of spleen enlargement, quality, the second step to understand the spleen enlargement Accompanied by symptoms and signs, usually through understanding of medical history and physical examination; by understanding the medical history, physical examination can make a preliminary diagnosis of the cause of splenomegaly, and then selectively do laboratory tests and necessary equipment examinations, and finally Make a diagnosis of the cause of splenomegaly.
Diagnosis
Diagnosis of splenomegaly
Diagnostic criteria
1. History of the disease to understand the history of the disease, the diagnosis of splenomegaly is important, pay attention to the onset of the disease, the length of the disease, past history, epidemiology, family history, age of the patient, gender and splenomegaly accompanying symptoms, etc. Can provide some clues for diagnosis, acute infection usually has an acute onset, short course of disease, mild spleen, chronic infection, hereditary diseases, metabolic diseases, slow onset, long course of disease, and the degree of swelling increases with the course of disease. Malignant tumors have a rapid development trend and can be significantly increased. Past history has also greatly improved the diagnosis of diseases, such as: history of viral hepatitis, long-term drinking history or history of blood transfusion and blood products, existing splenomegaly It may be chronic hepatitis or cirrhosis with portal hypertension; epidemics and endemic diseases often have epidemiological history; some diseases may have a family history, such as: Mediterranean anemia, metabolic diseases, etc.; Different ages and genders, such as: histiocytosis and lipidosis occur in infants and young children; infectious diseases in acute infectious diseases often occur in adolescents; malignant tissue Cytopathic, chronic viral hepatitis, cirrhosis is more common in young adults, men are more common in women; multiple myeloma occurs in older men; leukemia, malignant lymphoma can occur at any age; connective tissue disease occurs in young women, etc. Etc., accompanied by symptoms and signs of spleen enlargement, is an important clue to find the cause of spleen enlargement, such as: splenomegaly with fever, can be seen in a variety of acute and chronic infectious diseases; splenomegaly with anemia, fever, bleeding tendency often prompts leukemia spleen Large; splenomegaly with anemia, yellow staining suggests hemolytic anemia; spleen rhubarb often indicates chronic hepatitis or cirrhosis; splenomegaly with gastrointestinal symptoms or hematemesis may be cirrhotic portal hypertension; heart disease or pericardial effusion Congestive splenomegaly often has symptoms such as difficulty in breathing, palpitations, shortness of breath, etc., and so on, and other splenomegaly caused by various diseases, both of which have the characteristics of their respective diseases, and should be asked one by one in the medical history.
2. Clinical manifestations.
3. Laboratory and other auxiliary inspections.
Differential diagnosis
1. Infectious splenomegaly clinical manifestations of fever, rash, skin bruises, liver and spleen and lymph nodes, splenomegaly is generally mild, soft, such diseases include typhoid, sepsis, viral hepatitis, bacterial heart Membrane inflammation, malaria and other diseases can be diagnosed by the detection of corresponding pathogens.
2. Liver cirrhosis has a history of hepatitis or schistosomiasis infection, slow onset, clinical manifestations of weight loss, fatigue, loss of appetite, abdominal distension, bleeding tendency, ascites, etc., physical examination of abdominal wall varices, splenomegaly, mostly light, medium Swelling, schistosomiasis liver fibrosis can be expressed as giant spleen, advanced spleen hyperfunction can occur, through medical history, clinical manifestations, liver function tests, B-ultrasound and other tests can make a diagnosis.
3. Chronic hemolytic anemia caused by hemolysis of the spleen, generally mild, moderate swelling, symptoms of anemia, jaundice, etc., laboratory examination may have increased reticulocyte, bone marrow young red is active hyperplasia, serum indirect Or unbound bilirubin increased, urinary biliary increased.
4. The course of leukemia acute leukemia develops rapidly, manifesting as infection, anemia, hemorrhage and other symptoms, and the spleen is mildly swollen; chronic leukemia is slow onset, and with the development of the disease, the spleen can be highly swollen, and the peripheral blood can be seen immature. In early white blood cells, a large number of primordial cells or immature white blood cells can be seen in the bone marrow. Generally, according to peripheral blood images, bone marrow puncture can distinguish various types of leukemia.
5. Malignant lymphoma malignant lymphoma is characterized by painless local or systemic lymphadenopathy, with fever, enlarged liver, mild spleen, moderate swelling, lymph node biopsy and bone marrow smear can be found in RS cells. Or lymphoma cells.
6. The clinical manifestations of malignant histiocytosis have unexplained fever, failure, complete blood cell reduction, liver and spleen, and even the spleen can be significantly enlarged, usually multiple times, multi-site bone marrow smear or lymph node biopsy can find malignant tissue Cells can establish a diagnosis, and the alkaline phosphatase activity in peripheral blood neutrophils is reduced, which can assist in diagnosis.
