Hepatosplenomegaly (HPM)

Hepatosplenomegaly or HPM appears when both the spleen and the liver are enlarged. Its name derives from two main components:

  • hepatomegaly: swelling or enlargement of the liver
  • splenomegaly: swelling or enlargement of the spleen

Fortunately, 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.

What Are the Roles of the Liver and the Spleen?

The liver is very important for the human body. It helps detoxifying your blood, synthesizing proteins, and fighting infections. It is also very important because it is a key contributor in producing both amino acids and bile salts. In order to produce red blood cells, the body needs iron. The liver is able to process and store the iron.

The spleen is less understood by most people, even though it is also an important organ. First of all, it has a key place in your immune system. The spleen helps to identify pathogens. The pathogens are bacteria, viruses, or microorganisms and they are capable of causing diseases. It then creates antibodies to fight them. Your spleen also purifies the blood and is made up of red and white pulp necessary to produce and purify blood cells.

Symptoms

The main symptoms that people with hepatosplenomegaly experience are the following:

  • fatigue
  • pain

Patients suffering from this condition may also deal with other symptoms, which may be severe and that 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
  • brown urine
  • clay-colored stool

 Causes and risk factors

The risk factors for hepatomegaly are numerous and they include:

  • obesity
  • alcohol addiction
  • liver cancer
  • hepatitis
  • diabetes
  • high cholesterol

Splenomegaly comes, in most cases, as a consequence of hepatomegaly. There are many different potential causes of liver disease:

Infections

  • acute viral hepatitis
  • infectious mononucleosis, also known as glandular fever or the “kissing disease”, It is caused by the Epstein-Barr virus
  • cytomegalovirus known as a condition in the herpes virus family
  • brucellosis. This is a virus transmitted via contaminated food or contact with an infected animal
  • malaria is transmitted by mosquitos and can be life-threatening
  • leishmaniasis, a disease caused by the parasite Leishmania and spread through the bite of a sand fly
  • schistosomiasis is caused by a parasitic worm infecting the urinary tract or intestines
  • septicemic plague 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. It appears when the 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

  • Niemann-Pick disease is 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

When it comes to children, the common causes of hepatosplenomegaly are the following:

  • newborns: storage disorders and thalassemia
  • infants: liver unable to process glucocerebroside, which can lead to severe damage to the central nervous system
  • older children: malaria, kala-azar, enteric fever, and sepsis

Diagnosis

Once you feel any of the symptoms above, you should immediately see a doctor. Once your doctor will start examining you, he will follow the procedure below: :

  • an ultrasound – doctors typically recommend it when they find an abdominal mass during a physical exam
  • a CT scan 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 the diagnosis after the physical examination

 Complications

Hepatosplenomegaly can lead to the following complications:

  • bleeding
  • blood in stool
  • blood in vomit
  • liver failure
  • encephalopathy

Treatment

As every person is different, the treatments can also vary. Therefore, the best thing to do is to talk to your doctor about your diagnosis and recommendation of treatment.

The doctor may suggest:

  • Making lifestyle changes. The most important thing would be to stop drinking any alcohol, exercise as regularly as you are able; and enjoy a healthy diet.
  • Rest, hydration, and medication.
  • Cancer treatments. When the underlying cause is cancer, you need suitable treatments that may include chemotherapy, radiotherapy, and surgery to remove the tumor.
  • Liver transplant. If your case is severe, such as being in the final stages of cirrhosis, you may require a liver transplant.

References:

https://www.patientslikeme.com/conditions/1250-hepatosplenomegaly

https://www.healthline.com/health/hepatosplenomegaly#symptoms2

Hepatosplenomegaly

Hepatosplenomegaly

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