What are the causes of splenomegaly? Why does liver disease cause splenomegaly?

Love and be careful of the liver, pay attention not to get lost.

The spleen is the "blood bank" of the human body, when the human body rests, quiet, it stores blood, when in the state of exercise, blood loss, hypoxia and other stress states, it will discharge blood into the blood circulation to increase blood volume.

In addition, the spleen is also like a "filter", when germs, antigens, foreign bodies, and protozoa appear in the blood, macrophages and lymphocytes in the spleen will eat it.

The spleen can also produce immune substances such as immunoglobulins and complements to exert immune effects. The spleen is an important filter in the blood circulation, removing foreign bodies, germs, and senescent dead cells, especially red blood cells and platelets, from the blood.

Many people do physical examination will find spleen on the B ultrasound report, generally speaking, the thickness of the normal spleen is not more than 40mm, the length is not more than 120mm, if the thickness and length exceed the standard, it may be splenomegaly.

There are many clinical causes of splenomegaly. If there is a history of chronic hepatitis, once splenomegaly occurs, be alert to the presence of cirrhosis.

Causes of splenomegaly include:

1. Right heart dysfunction: hepatic congestion, splenomegaly.

2. Cirrhosis: liver fibrosis, cirrhosis and other substantial liver diseases can lead to increased vascular pressure, which in turn leads to congestive splenomegaly. The exact mechanism is unknown. Contributing factors include portal vein congestion, hemodynamic changes, and inflammatory mediators.

3. Regional portal hypertension: also known as left portal hypertension, often caused by a variety of reasons for simple splenic vein obstruction, resulting in a higher pressure in the portal vein spleen and stomach area than normal.

4. Leukemia: splenomegaly is one of the main symptoms of patients with chronic myelogenous leukemia.

5. Myelofibrosis: characterized by anemia, myelofibrous tissue hyperplasia and extramedullary hematopoiesis. Hepatosplenomegaly is present.

6. Acute splenal infarction: common causes include hematologic diseases and coagulation disorders.

7. Mononucleosis: acute proliferative infectious diseases of the monocyte-macrophage system characterized by high fever, angina and hepatosplenic lymphadenopathy mainly caused by Epstein-Barr virus infection, showing a self-limiting process and most of them have a good prognosis.

8. AIDS: Splenomegaly causes may be related to chronic virology or other microbial infections of the spleen, and may also come from lymphoma (AIDS is common).

9. Spleen sarcoma-like disease: enlargement of the spleen, diffuse, multiple, small low-density granulomas, often accompanied by dare to fight, multiple small nodule granulomas in the liver.

10. Neoplastic lesions of the spleen.

11. Gaucher disease: an autosomal recessive inheritance. He is often treated with a large spleen.

12. Amyloid disease: metabolic-related lesions, manifested by abnormal protein deposition in one or more organs. Often leads to hepatosplenomegaly.

13. Others: polycythemia vera; hemoglobinosis; chronic hepatitis; intravenous drug abuse; collagen vascular disease; malaria; diabetes; glycogen storage; hemosiderosis, etc.

The texture of spleen can vary to varying degrees due to different etiologies. Spleen is generally soft due to acute infection.

The spleen caused by chronic infection, leukemia cells, and tumor cell infiltration is hard and uneven.

The texture of the congestion spleen varies depending on the degree of bruising and the length of the congestion time, the time is short, the congestion is light, the texture is soft, the time is long or the congestion is heavy and hard, but there is generally a sense of fullness.

Why do people with liver disease develop splenomegaly?

In patients with acute hepatitis, after active treatment, some patients will be cured and some will turn into chronic hepatitis.

Patients with chronic hepatitis are treated, some of whom are controlled and some of whom progress to cirrhosis. Splenomegaly may occur during this process, whether in the acute hepatitis phase, in the chronic hepatitis phase, or in patients who have progressed to cirrhosis.

When acute hepatitis occurs, the causative factors act on the liver, various inflammatory cell infiltrates and / or eosinophil infiltration, hepatosplenial intranetulocyte proliferation and phagocytosis occur, so that the spleen congestion, enlargement. With aggressive treatment, liver inflammation is controlled, and the enlarged spleen gradually retracts to normal as the condition resolves.

Inflammatory activity in patients with chronic hepatitis may have an enlarged spleen. Some patients with chronic hepatitis have inflammatory activity, if they get timely and reasonable treatment, liver inflammation has been controlled and stabilized for a long time, usually the spleen will not be enlarged; but there are also some patients with chronic hepatitis who have inflammatory activity and do not get timely treatment, and splenomegaly will occur. After that, despite aggressive treatment, liver inflammation is controlled, and some patients have enlarged spleen that cannot return to normal.

Most patients with cirrhosis develop splenomegaly.

In the physiological state, blood from the spleen vein, portal vein, superior mesenteric vein, etc. flows from the portal vein to the liver and gathers in the inferior vena cava for systemic circulation. In cirrhosis, the circulation in the liver is severely damaged, and the return of blood to the portal vein system is blocked, causing its pressure to increase, forming an important pathological change in cirrhosis, that is, "portal hypertension". Since the spleen vein flows directly into the portal vein, if the portal vein is hypertension, the return of the spleen vein can be blocked, the reticuloendothelial cells and fibrous tissue can proliferate, and the spleen is bruised, so that the spleen is congestive and enlarged, and the spleen is also hypertrophic.

Among them, there is no abnormality in the resting phase of cirrhosis, multiple examinations of transaminases and serum viruses for many years, the lesions are no longer active, cirrhosis may have occurred in the past when the lesions were active, and splenomegaly appeared. If there is no hyperplenism on the blood routine examination, gastroscopy does not have gastroesophageal varices, even if there is mild cirrhosis, as long as there is no alcohol and no exertion, it has little impact on life, work and life.

Spleen enlargement, mostly 2 to 3 times normal, swelling is obvious, the lower edge of the spleen can reach the level of flat umbilicus or subumbilicus, generally splenomegaly to a certain extent after no longer enlarged. The spleen can shrink if there is heavy bleeding in the upper gastrointestinal tract or if the portal vein pressure drops after surgery.

The enlarged spleen is hard and tender, but a small number of patients with cirrhosis portal hypertension remain asplenialess.