Hepatolienal syndrome: causes, symptoms, diagnosis, treatment

Hepatolyenal syndrome is a combined increase in the spleen and liver caused by both a protective reaction to microbial aggression and a specific joint lesion of these organs. The combined reaction of the liver and spleen is due to their anatomical and physiological generality, in particular, participation in the systemic inflammatory reaction, nonspecific protective reactions, the formation of specific immunity.

[1], [2], [3]

Symptoms of hepatolyenal syndrome

With a slight degree of severity of hepatolyenal syndrome, the liver protrudes from the edge of the edge arch by 1-2 cm, the spleen is palpable in the hypochondrium or its increase is determined by percussion. With a moderate degree of hepatolyenal syndrome, the liver protrudes from the edges of the edge arch by 2-4 cm, the spleen is palpable at the rib margin or protrudes 1-2 cm from under it. A pronounced hepatolienal syndrome is characterized by a liver enlargement of more than 4 cm, a spleen - more than 2 cm below the edge edge. The soft consistency of organs is characteristic of acute infections, dense - for acute and subacute infections, usually occurring with severe fever or organ damage (viral hepatitis, malaria). The dense consistency of the liver and spleen is characteristic of chronic infections (hepatitis, recurrent or untreated malaria, brucellosis). The stony density of organs, especially the liver, is characteristic of parasitic (echinococcosis) or tumor lesions (hepatocellular carcinoma). More often the liver and spleen are painless or sensitive on palpation, more pronounced tenderness is observed with a significant and rapid increase in organs, for example, in hemolysis. Sharp soreness may indicate a local suppuration (abscess of the liver with amebiasis, abscess of the spleen with sepsis). For infectious diseases accompanied by significant splenomegaly (infectious mononucleosis), care should be taken when examining and transporting the patient due to the danger of rupture of the spleen.

In acute and chronic infectious diseases, factors such as edema, hyperemia, infiltration with lymphoid elements or granulocytes, proliferation and hyperplasia of macrophage-histiocytic elements, proliferation of connective tissue lie at the base of the increase in the size of organs. Hepatolyenal syndrome is accompanied by a violation of the liver and spleen (pathology of pigment metabolism, changes in protein composition of the plasma, hyperfermentemia, anemia, leukopenia, thrombocytopenia, etc.).

Hepatolienal syndrome in many common infectious diseases has an important diagnostic value (malaria, infectious mononucleosis, brucellosis, typhoid fever and paratyphoid A and B, typhus and other rickettsiosis, sepsis). Hepatolyenal syndrome completely excludes influenza and other acute respiratory viral infections, except for adenovirus infection, cholera, dysentery and a number of other diseases.

Frequency of hepatolienal syndrome in infectious and parasitic diseases

Registration of hepatolienal syndrome	Nosological forms
Constantly meets	Visceral leishmaniasis, infectious mononucleosis, tick-borne return borreliosis, malaria, epidemic recurrent typhus
Common, typical	Brucellosis, typhoid fever, HIV infection, mononucleosis-like syndrome, HBV, HBV with delta antigen, acute HCV, chronic viral hepatitis. Leptospirosis, listeriosis (septic form), opisthorchiasis (acute phase) paratyphoid A, B, rickettsiosis, sepsis, typhus, trypanosomiasis, fascioliasis (acute phase), CMVI, congenital plague (septic form)
Available	Adenovirus infection, HAV and VGE, chronic disseminated histoplasmosis, benign lymphoreticulosis, generalized iersiniosis, measles, rubella, fever, Marburg fever, ornithosis, generalized pseudotuberculosis, generalized salmonella, acute toxoplasmosis, acquired trichinosis, CMVI acquired, dystostomy (acute period)
Rarely, not typical	Chickenpox, HFRS, HCV acute, herpes simple generalized, yellow fever, KGL, HLD, Lassa fever, pappataci fever, Ebola fever, mycoplasmosis pulmonary smallpox, OGL, shingles, PTI, strongyloidiasis. Enterovirus infection
Does not occur	Amybiasis, ankylostomiasis, ascariasis, balantidiasis, rabies, botulism, influenza, dysentery, Ixodes tick-borne borreliosis, campylobacteriosis, candidiasis, tick-borne encephalitis, cutaneous leishmaniasis, coccidia, coronavirus infection, lymphocytic choriomeningitis, LZN, parainfluenza, parotitis, poliomyelitis, prion diseases, reovirus infection, respiratory syncytial infection, rotavirus infection, tetanus, toxocarosis, trichocephalosis, filariasis, cholera, cestodoza, escherichiosis, Japanese encephalitis

In addition to the method of percussion and palpation, enlarged liver and spleen diagnosed with ultrasound and CT. With meteorism, the spleen is shy in the hypochondrium and palpation may be unavailable. With sepsis, typhus, the spleen is soft, poorly defined palpation and weak echo. In the presence of free gas in the abdominal cavity (perforation of the hollow organ) it is difficult to determine the boundaries of the liver. CT is used for a detailed study of the structure of organs in terms of differential diagnosis.

Classification of hepatolienal syndrome

There is no generally accepted classification. In practice, hepatolienal syndrome is classified as follows.

• By the degree of expression of the increase in organs:
  • light (weak):
  • moderate;
  • sharp (strong).
• According to the consistency of organs:
  • soft;
  • dense;
  • dense;
  • "Stony" is dense.
• By sensitivity:
  • painless:
  • sensitive,
  • painful;
  • sharply painful.
• By duration:
  • short-term - up to 1 week; o acute - up to 1 month; o subacute - up to 3 months; about chronic - more than 3 months.

Also assess the surface of the organs (smooth, bumpy).

[4], [5], [6], [7]

Treatment of hepatolienal syndrome

The presence of hepatolienal syndrome does not require the use of special methods of treatment. Regression of hepatolyenal syndrome against the background of ongoing etiotropic therapy testifies to its effectiveness.