Hepatolienal syndrome: causes, symptoms, diagnosis, treatment

Hepatosplenic syndrome is a combined enlargement of 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 commonality, in particular, participation in the systemic inflammatory reaction, non-specific protective reactions, and the formation of specific immunity.

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Symptoms of hepatosplenic syndrome

In mild hepatosplenic syndrome, the liver protrudes from under the costal margin by 1-2 cm, the spleen is palpated in the hypochondrium or its enlargement is determined by percussion. In moderate hepatosplenic syndrome, the liver protrudes from under the costal margin by 2-4 cm, the spleen is palpated at the costal margin or protrudes from under it by 1-2 cm. Severe hepatosplenic syndrome is characterized by an enlargement of the liver by more than 4 cm, and of the spleen by more than 2 cm below the costal margin. Soft consistency of the organs is typical of acute infections, dense consistency is typical of acute and subacute infections, usually occurring with severe fever or organ damage (viral hepatitis, malaria). Dense consistency of the liver and spleen is typical of chronic infections (hepatitis, recurrent or untreated malaria, brucellosis). Stony density of organs, especially the liver, is typical of parasitic (echinococcosis) or tumor lesions (hepatocellular carcinoma). Most often, the liver and spleen are painless or sensitive to palpation, more pronounced pain is observed with significant and rapid enlargement of the organs, for example, with hemolysis. Sharp pain may indicate a local suppurative process (liver abscess in amebiasis, spleen abscess in sepsis). In infectious diseases accompanied by significant splenomegaly (infectious mononucleosis), caution should be exercised when examining and transporting the patient due to the risk of rupture of the spleen.

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

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

Frequency of hepatosplenic syndrome in infectious and parasitic diseases

Registration of hepatosplenic syndrome	Nosological forms
Constantly encountered	Visceral leishmaniasis, infectious mononucleosis, tick-borne relapsing borreliosis, malaria, epidemic relapsing fever
Often encountered, characteristic	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), CMV, congenital plague (septic form)
Possible	Adenovirus infection, HAV and HEV, chronic disseminated histoplasmosis, benign lymphoreticulosis, generalized yersiniosis, measles, rubella, Q fever, Marburg fever, ornithosis, generalized pseudotuberculosis, generalized salmonellosis, acute toxoplasmosis, acquired trichinosis, acquired CMV, schistostomiasis (acute period)
Rare, not typical	Chickenpox, HFRS, acute HCV, herpes simplex generalized, yellow fever, CHF, DHF, Lassa fever, pappataci fever, Ebola fever, pulmonary mycoplasmosis, smallpox, OHF, herpes zoster, PTI, strongyloidiasis. enterovirus infection
Does not occur	Amebiasis, ancylostomiasis, ascariasis, balantidiasis, rabies, botulism, influenza, dysentery, Ixodes tick-borne borreliosis, campylobacteriosis, candidiasis, tick-borne encephalitis, cutaneous leishmaniasis, coccidiosis, coronavirus infection, lymphocytic choriomeningitis, WNV, parainfluenza, mumps, poliomyelitis, prion diseases, reovirus infection, respiratory syncytial infection, rotavirus infection, tetanus, toxocariasis, trichuriasis, filariasis, cholera, cestodiasis, escherichiosis, Japanese encephalitis

In addition to percussion and palpation, enlarged liver and spleen are diagnosed using ultrasound and CT. With flatulence, the spleen is constrained in the hypochondrium and may not be accessible to palpation. With sepsis and typhus, the spleen is soft, poorly palpated and weakly echogenic. With free gas in the abdominal cavity (perforation of a 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 diagnostics.

Classification of hepatosplenic syndrome

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

• By the degree of organ enlargement:
  • light (weak):
  • moderate;
  • sharp (strong).
• By the consistency of organs:
  • soft;
  • dense;
  • dense;
  • "rocky" - dense.
• By sensitivity:
  • painless:
  • sensitive,
  • painful;
  • sharply painful.
• By duration:
  • short-term - up to 1 week; acute - up to 1 month; subacute - up to 3 months; chronic - more than 3 months.

The surface of the organs is also assessed (smooth, bumpy).

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Treatment of hepatosplenic syndrome

The presence of hepatosplenic syndrome does not require the use of special treatment methods. Regression of hepatosplenic syndrome against the background of the conducted etiotropic therapy indicates its effectiveness.