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جامعة تكريت
/ كلية الطب / فرع طب االطفال / أ.د. احمد
هاشم عبد الغفور
Fever and Hepatosplenomegaly
Objectives : the objectives of this lecture are to
know :
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Overview
Hepatosplenomegaly (HPM) is a disorder where both the liver and
spleen swell beyond their normal size, due to one of a number of
causes.
The name of this condition — hepatosplenomegaly — comes from
the two words that comprise it:
hepatomegaly: swelling or enlargement of the liver
splenomegaly: swelling or enlargement of the spleen
Not all cases of HPM are severe. Some may be cleared up with
minimal intervention. However, HPM can indicate a serious problem,
such as a lysosomal storage disorder or cancer.
Roles of the liver and the spleen
The liver has a variety of roles including detoxifying your blood,
synthesizing proteins, and fighting infections. It also has a key part in
producing both amino acids and bile salts.
Your body needs iron to produce red blood cells, and your liver
processes and stores that iron. Perhaps the most well-known of your
liver’s roles is the processing of your body’s waste matter, which can
then be excreted.
The spleen is one of your body’s organs that is, by and large, less
understood by most people. The spleen has a key place in your
immune system. It helps it to identify pathogens, which are bacteria,
viruses, or microorganisms capable of causing diseases. It then
creates antibodies to fight them.
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Your spleen also purifies the blood and is made up of red and white
pulp necessary to produce and purify blood cells. Learn even more
about the spleen.
Symptoms
People with hepatosplenomegaly may report one or more of the
following symptoms:
pain
Other symptoms, which may be severe, include:
abdominal pain in the upper-right region
tenderness in the right region of the abdomen
nausea and vomiting
swelling of the abdomen
fever
persistent itching
jaundice, indicated by yellow eyes and skin
Causes and risk factors
Splenomegaly is caused by hepatomegaly about 30 percent of the
time. There are many different potential causes of liver disease:
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Infections
acute viral hepatitis
infectious mononucleosis, also known as glandular fever or the
“kissing disease” and caused by the Epstein-Barr virus
cytomegalovirus, a condition in the herpes virus family
brucellosis, a virus transmitted via contaminated food or contact
with an infected animal
malaria, a mosquito-borne infection that can be life-threatening
leishmaniasis, a disease caused by the parasite Leishmania and
spread through the bite of a sand fly
schistosomiasis, which is caused by a parasitic worm infecting the
urinary tract or intestines
septicemic plague, which is caused by a Yersinia pestis infection
and can be life-threatening
Hematological diseases
myeloproliferative disorders, in which the bone marrow produces
too many cells
leukemia, or cancer of the bone marrow
lymphoma, or a blood cell tumor originating in lymphatic cells
sickle cell anemia, a hereditary blood disorder found in children in
which hemoglobin cells are not able to transfer oxygen
thalassemia, an inherited blood disorder in which hemoglobin is
formed abnormally
myelofibrosis, a rare cancer of the bone marrow
Metabolic diseases
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Niemann-Pick disease, a severe metabolic disorder involving fat
accumulation in cells
Gaucher’s disease, a genetic condition that causes fat accumulation
in different organs and cells
Hurler syndrome, a genetic disorder with increased risk of early
death through organ damage
Other conditions
chronic liver disease, including chronic active hepatitis
amyloidosis, a rare, abnormal accumulation of folded proteins
systemic lupus erythematosus, the most common form of the
autoimmune disease lupus
sarcoidosis, a condition in which inflammatory cells are seen in
different organs
trypanosomiasis, a parasitic disease transmitted via the bite of an
infected fly
multiple sulfatase deficiency, a rare enzyme deficiency
osteopetrosis, a rare inherited disorder in which bones are harder
and denser than normal
Diagnosis
These are a number of tests that may order to help make a definitive
diagnosis of hepatosplenomegaly. These are:
CBP and ESR and retics count: Hemolytic disease. malignancies
Serological tests : Typhoid fever, brucellosis , visceral lieshmaniasis
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an ultrasound, which is typically recommended after an abdominal
mass is found during a physical exam
a CT scan, which can reveal an enlarged liver or spleen as well as
surrounding organs
blood tests, including a liver function test and a blood clotting test
an MRI scan to confirm diagnosis after physical examination
Treatment
Treatments for hepatosplenomegaly can vary from person to person
depending on the cause of the condition.