Hepatosplenomegaly

Hepatomegaly refers to a condition in which the liver is enlarged or swollen beyond its normal size (sometimes called simply “enlarged liver”). Splenomegaly refers to a similar condition afflicting the spleen, and so hepatosplenomegaly refers to a condition in which both the liver and the spleen are enlarged or swollen.

Diagnosis is usually made during a clinical examination, especially through use of medical imaging technology such as an ultrasound, which can reveal the swelling in the liver and the spleen.

Causes

If causes of both hepatomegaly and splenomegaly happen both to be present, the result can be that both organs are enlarged. However, the most common cause of hepatosplenomegaly is infectious mononucleosis, commonly known as mono. This disease is commonly diagnosed in teenage patients (especially age 15 to 17), is sometimes known as “kissing disease” because it can be transmitted through exchange of bodily fluids such as saliva, and in addition to hepatosplenomegaly can cause swollen lymph nodes, sore throat, and high fever.

Acute viral hepatitis can also cause hepatosplenomegaly. This is primarily a liver disease, an infection of the liver caused by any of the five variants of the hepatitis virus, with type A and B being the most common, but it can also cause swelling of the spleen. In addition to hepatosplenomegaly, other symptoms of acute viral hepatitis are loss of appetite, pain, swelling of the abdomen, and jaundice (yellowing of the skin and of the whites of the eyes).

Patients with either acute viral hepatitis or infectious mononucleosis usually make a full recovery within a few weeks, in which both the liver and the spleen return to normal size and function as well as other symptoms disappearing. In addition to these common causes, other infections and non-infectious diseases can produce hepatosplenomegaly. Among the possible causes are rubella, malaria, schistosomiasis, leukemia, lymphoma, pernicious anemia, sickle-cell anemia, and chronic liver damage.

There is however a more serious group of diseases that can cause hepatosplenomegaly, called lysosomal storage disorders or LSDs. These are rare genetic diseases, some fifty in number, involving the absence or deficiency of enzymes necessary for the breakdown of macromolecules within the lysosomes of the cells.

Lysosomes are small organelles bound by membranes that contain acid hydrolase enzymes and are important for breaking down waste materials in the cells. Sometimes the lysosome is referred to as the cell’s recycling center. It breaks down wastes and other undesirable material into substances the cells can use. A failure to produce the necessary enzymes in sufficient quantity can be a very serious illness. Lysosomal storage disorders mostly strike children and are quite often fatal. As these are genetic disorders, they are difficult to treat. In addition to hepatosplenomegaly, LSDs can produce seizures, dementia, and sensory malfunction including blindness and deafness.  Pulmonary and cardiac problems are a common complication, as is abnormal growth of the bones.

Treatment

As with most symptoms of liver disease, treatment of enlarged liver and spleen consists of treatment of the underlying condition, or of the causes of the underlying condition. That means in this case treating the infection or non-infectious disease that is causing the symptom.

Unlike many liver-related problems, alcohol abuse is not often associated with hepatosplenomegaly. However, if the condition is related to chronic liver damage, and if alcohol abuse is the culprit behind the manifestation of that disease, then cessation of drinking may be indicated. In most cases of mononucleosis, treatment consists of bed rest and avoidance of activity for a period of time, together with high fluid intake and symptomatic treatment with acetaminophen (Tylenol).

Similar treatment is prescribed for acute infectious hepatitis along with abstinence from alcohol and fatty foods.