Hepatosplenomegaly
Introduction
Introduction Both the liver and the spleen increase. Liver and spleen can not be touched under the ribs. When the visceral sag or the sag is lowered or deep inhalation, the liver and spleen can be touched, but not more than 1cm under the rib, and the texture is soft. Hepatosplenomegaly is common in chronic hepatitis, typhoid fever, schistosomiasis, early cirrhosis, and leukemia. In granulocyte leukemia, high splenomegaly is seen.
Cause
Cause
There are many causes of hepatosplenomegaly, and there are several types of inductive analysis:
1. The cause of hepatomegaly:
(1) fatty liver.
(2) Hemosiderinosis.
(3) Hepatic glycogen accumulation syndrome.
(4) Hepatolenticular degeneration.
(5) Schistosomiasis.
(6) Liver flukes.
(7) Toxoplasma gondii.
(8) Cytomegalovirus infection.
(9) Rubella virus infection.
(10) Hepatitis B virus infection.
(11) Congenital biliary atresia.
(12) Hepatocarcinoma.
(13) Keshan disease.
(14) Paragonimiasis.
(15) Hepatic echinococcosis.
(16) Toxic hepatitis.
(17) Galactoseemia.
(18) Liver amyloidosis.
(19) Portal hypertension.
2, the cause of splenomegaly:
(1) Cytomegalovirus infection.
(2) Rubella infection.
(3) Hepatitis B virus infection.
(4) Infectious mononucleosis.
(5) Toxoplasmosis.
(6) Schistosomiasis.
(7) Hydatid disease.
(8) Amyloidosis.
(9) High snow disease.
(10) Galactoseemia.
(11) Hyperlipoproteinemia.
(12) Fanconi syndrome.
(13) spleen.
(14) Paget's syndrome.
(15) Mucopolysaccharide type I.
(16) Histoplasmosis.
(17) Black fever.
Examine
an examination
Related inspection
Liver function test liver, gallbladder, spleen CT examination
The relationship between liver, gallbladder, pancreas and small intestine is very important to determine the cause of hepatosplenomegaly and to determine liver function. Sometimes the clinical symptoms are not obvious, but the liver function is abnormal after laboratory tests. Laboratory tests are also essential for assessing the extent of liver damage and its prognosis.
blood test
1. Blood: White blood cell count and cell morphology observation have diagnostic value for infectious diseases and leukemia. Hemoglobin, red blood cells, increased reticulocytes, suggesting hemolytic anemia.
2. Liver function tests: examination of liver function, hepatitis B surface antigen (HBsAg), hepatitis B core antigen and E antigen. The cephalin flocculation test and the zinc sulfate turbidity test in the liver function test. Alanine aminotransferase and aspartate aminotransferase are also abundant in heart and muscle tissues, and such enzymes can be released to the bloodstream in large amounts after asphyxiation. Lactate dehydrogenase increased in hepatitis, and did not increase in obstructive jaundice, suggesting that the enzymes of cholestasis include alkaline phosphatase, leucine aminotranspeptidase and -glutamyltranspeptidase, etc., serum 5-nucleoside Acidase is also significantly increased in biliary atresia.
3, pathogen examination: blood bacterial culture, virus isolation and detection of specific antibodies, can help determine the type of bacteria and viruses that cause infection.
4, other tests: If suspected abnormal glucose metabolism should be measured blood sugar and glucose tolerance test. For the diagnosis of blood group incompatibility, direct anti-human globulin test, free antibody assay and antibody release test are required. Serum protein electrophoresis, a fetal protein, immunoglobulin and other tests can be selected as needed.
Bone marrow examination
Considering a blood vessel or malignant cell proliferation should be done with bone marrow puncture, which is valuable for the diagnosis of leukemia, thrombocytopenic purpura, malaria, etc.
Liver biopsy
For patients with unexplained hepatosplenomegaly or suspected tumors, biopsy may be taken after liver and spleen puncture. Such as the diagnosis of primary liver tumors or secondary tumors.
Film degree exam
1, B-mode ultrasound: Ultrasound examination can help determine the size of the liver and spleen, ultrasound scan can be used to observe the liver position, shape, size, check the diaphragm movement, showing the relationship between the liver and adjacent organs. Ultrasound can also provide etiological data. B-mode ultrasound is very useful for the identification of intrahepatic masses such as hepatic cysts, liver abscesses and liver tumors. Liver cirrhosis, fatty liver and hepatic liver can also be distinguished under ultrasound images. Ultrasound examination of the gallbladder can detect the presence of a choledochal cyst. Ultrasound examination can observe the location, shape and size of the spleen, and the influence of abdominal muscle tension and other factors on it. Ultrasound examination is used to determine that the splenomegaly is more sensitive and correct than palpation, and can display internal structure, which can be distinguished from hematologic splenomegaly, lymphogranuloma, primary tumor of spleen and subserosal hematoma.
2, radionuclide examination: radionuclide examination can also be used for the diagnosis of hepatosplenomegaly, colloid 99mTc is used to understand the location, shape, size of the liver and to detect the presence or absence of lesions in the liver. The spleen can be developed simultaneously with the liver. When the spleen function is normal, the spleen shadow is lighter than the right lobe of the liver. When the spleen function is hyperthyroidism, the spleen shadow can be concentrated on the liver shadow. It is also useful for the diagnosis of lesions and infiltrative lesions in the spleen.
Diagnosis
Differential diagnosis
Hepatosplenomegaly needs to be differentiated from the following symptoms.
1, chronic inactive hepatitis: symptoms are generally not much, the symptoms do not deteriorate after the activity, occasionally fatigue, poor appetite, occasionally right upper abdominal fullness, most of the liver swelling without tenderness, liver function is mostly within the normal range.
2, cirrhosis: The main clinical manifestations of cirrhosis are liver, splenomegaly, splenomegaly is very common. However, diseases that may cause splenomegaly, such as malaria, kala-azar, and schistosomiasis, should be excluded. Splenomegaly has a certain significance in the diagnosis. X-ray examination of the esophagus or fundus with or without varices is extremely valuable for the diagnosis of cirrhosis. Generally, it is not difficult to distinguish between medical history, physical signs, liver function test and chronic hepatitis. The sodium tetrabromide sulfonate (BSP) test is very helpful. Ultrasound can help diagnose. Liver biopsy can confirm chronic hepatitis or cirrhosis, but It is necessary to strictly control its indications.
